Neural proteins as biomarkers for nervous system injury and other neural disorders

ABSTRACT

The present invention identifies biomarkers that are diagnostic of nerve cell injury and/or neuronal disorders. Detection of different biomarkers of the invention are also diagnostic of the degree of severity of nerve injury, the cell(s) involved in the injury, and the subcellular localization of the injury.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. Ser. No. 15/340,002, filedNov. 1, 2016, now U.S. Pat. No. 9,810,698, which is a continuation ofU.S. Ser. No. 12/950,142, filed Nov. 19, 2010, now U.S. Pat. No.9,664,694, which is a continuation of U.S. Ser. No. 12/822,560, filedJun. 24, 2010, now U.S. Pat. No. 8,492,107, which is acontinuation-in-part of U.S. Ser. No. 12/137,194, filed Jun. 11, 2008,now abandoned, which is a divisional of U.S. Ser. No. 11/107,248, filedApr. 15, 2005, now U.S. Pat. No. 7,396,654, which claims the benefit ofU.S. Provisional Application Ser. No. 60/562,944, filed Apr. 15, 2004,the disclosures of which are hereby incorporated by reference in theirentirety, including all figures, tables and amino acid or nucleic acidsequences.

The invention was made with government support under Grant NS039091awarded by the National Institutes of Health and Grant NS040182 awardedby the National Institutes of Health and Grants DAMD 17-99-1-9565 andDAMD 17-01-1-0765 awarded by the United States Army. The government hascertain rights in the invention.

FIELD OF THE INVENTION

The invention provides for the reliable detection and identification ofbiomarkers, important for the diagnosis and prognosis of damage to thenervous system (central nervous system (CNS) and peripheral nervoussystem (PNS)), brain injury and neural disorders. The protein/peptideprofile in patients with damage to nerves and brain cells aredistinguished from normal individuals using inexpensive techniques.These techniques provide simple yet sensitive approaches to diagnosingdamage to the central nervous system, brain injury and neuronaldisorders using biological fluids.

BACKGROUND OF THE INVENTION

The incidence of traumatic brain injury (TBI) in the United States isconservatively estimated to be more than 2 million persons annually withapproximately 500,000 hospitalizations. Of these, about 70,000 to 90,000head injury survivors are permanently disabled. The annual economic costto society for care of head-injured patients is estimated at $25billion. These figures are for the civilian population only and theincidence is much greater when combat casualties are included. In modernwarfare (1993-2000), TBI is the leading cause of death (53%) amongwounded who have reached medical care facilities.

Assessment of pathology and neurological impairment immediately afterTBI is crucial for determination of appropriate clinical management andfor predicting long-term outcome. The outcome measures most often usedin head injuries are the Glasgow Coma Scale (GCS), the Glasgow OutcomeScale (GOS), computed tomography, and magnetic resonance imaging (Mill)to detect intracranial pathology. However, despite dramatically improvedemergency triage systems based on these outcome measures, most TBIsuffer long term impairment and a large number of TBI survivors areseverely affected despite predictions of “good recovery” on the GOS. Inaddition, CT and MM are expensive and cannot be rapidly employed in anemergency room environment. Moreover, in austere medical environmentsassociated with combat, accurate diagnosis of TBI would be an essentialprerequisite for appropriate triage of casualties.

The mammalian nervous system comprises a peripheral nervous system (PNS)and a central nervous system (CNS, comprising the brain and spinalcord), and is composed of two principal classes of cells: neurons andglial cells. The glial cells fill the spaces between neurons, nourishingthem and modulating their function. Certain glial cells, such as Schwanncells in the PNS and oligodendrocytes in the CNS, also provide aprotective myelin sheath that surrounds and protects neuronal axons,which are the processes that extend from the neuron cell body andthrough which the electric impulses of the neuron are transported. Inthe peripheral nervous system, the long axons of multiple neurons arebundled together to form a nerve or nerve fiber. These, in turn, may becombined into fascicles, wherein the nerve fibers form bundles embedded,together with the intraneural vascular supply, in a loose collagenousmatrix bounded by a protective multilamellar sheath. In the centralnervous system, the neuron cell bodies are visually distinguishable fromtheir myelin-ensheathed processes, and are referenced in the art as grayand white matter, respectively.

During development, differentiating neurons from the central andperipheral nervous systems send out axons that must grow and makecontact with specific target cells. In some cases, growing axons mustcover enormous distances; some grow into the periphery, whereas othersstay confined within the central nervous system. In mammals, this stageof neurogenesis is complete during the embryonic phase of life andneuronal cells do not multiply once they have fully differentiated.

Accordingly, the neural pathways of a mammal are particularly at risk ifneurons are subjected to mechanical or chemical trauma or to neuropathicdegeneration sufficient to put the neurons that define the pathway atrisk of dying. A host of neuropathies, some of which affect only asubpopulation or a system of neurons in the peripheral or centralnervous systems have been identified to date. The neuropathies, whichmay affect the neurons themselves or the associated glial cells, mayresult from cellular metabolic dysfunction, infection, exposure to toxicagents, autoimmunity dysfunction, malnutrition or ischemia. In somecases the cellular dysfunction is thought to induce cell death directly.In other cases, the neuropathy may induce sufficient tissue necrosis tostimulate the body's immune/inflammatory system and the mechanisms ofthe body's immune response to the initial neural injury then destroysthe neurons and the pathway defined by these neurons.

Another common injury to the CNS is stroke, the destruction of braintissue as a result of intracerebral hemorrhage or infarction. Stroke isa leading cause of death in the developed world. It may be caused byreduced blood flow or ischemia that results in deficient blood supplyand death of tissues in one area of the brain (infarction). Causes ofischemic strokes include blood clots that form in the blood vessels inthe brain (thrombus) and blood clots or pieces of atherosclerotic plaqueor other material that travel to the brain from another location(emboli). Bleeding (hemorrhage) within the brain may also cause symptomsthat mimic stroke. The ability to detect such injury is lacking in theprior art.

Mammalian neural pathways also are at risk due to damage caused byneoplastic lesions. Neoplasias of both the neurons and glial cells havebeen identified. Transformed cells of neural origin generally lose theirability to behave as normal differentiated cells and can destroy neuralpathways by loss of function. In addition, the proliferating tumors mayinduce lesions by distorting normal nerve tissue structure, inhibitingpathways by compressing nerves, inhibiting cerebrospinal fluid or bloodsupply flow, and/or by stimulating the body's immune response.Metastatic tumors, which are a significant cause of neoplastic lesionsin the brain and spinal cord, also similarly may damage neural pathwaysand induce neuronal cell death.

There is thus, a need in the art appropriate, specific, inexpensive andsimple diagnostic clinical assessments of nervous system injury severityand therapeutic treatment efficacy. Thus identification of neurochemicalmarkers that are specific to or predominantly found in the nervoussystem (CNS (brain and spinal cord) and PNS), would prove immenselybeneficial for both prediction of outcome and for guidance of targetedtherapeutic delivery.

SUMMARY

The present invention provides neuronal protein markers that aredifferentially present in the samples of patients suffering from neuralinjury and/or neuronal disorders as compared to samples of controlsubjects. The present invention also provides sensitive and quickmethods and kits that can be used as an aid for diagnosis of neuralinjury and/or neuronal disorders by detecting these markers. Themeasurement of these markers, alone or in combination, in patientsamples provides information that a diagnostician can correlate with aprobable diagnosis of the extent of neural injury such as in traumaticbrain injury (TBI) and stroke.

In a preferred embodiment, the invention provides biomarkers that areindicative of traumatic brain injury, neuronal damage, neural disorders,brain damage, neural damage due to drug or alcohol addiction, diseasesassociated with the brain or nervous system, such as the central nervoussystem. Preferably, the biomarkers are proteins, fragments orderivatives thereof, and are associated with neuronal cells, brain cellsor any cell that is present in the brain and central nervous system.

In a preferred embodiment the biomarkers are preferably neural proteins,peptides, fragments or derivatives thereof. Examples of neural proteins,include, but are not limited to axonal proteins, amyloid precursorprotein, dendritic proteins, somal proteins, presynaptic proteins,post-synaptic proteins and neural nuclear proteins.

In another preferred embodiment the biomarkers are selected from atleast one protein, peptide, variant or fragment thereof, such as thoseproteins listed in Table 1 below. For example, Axonal Proteins: α IIspectrin (and SPDB)-1, NF-68 (NF-L)-2, Tau-3, α II, III spectrin, NF-200(NF-H), NF-160 (NF-M), Amyloid precursor protein, α internexin;Dendritic Proteins: beta III-tubulin-1, p24 microtubule-associatedprotein-2, alpha-Tubulin (P02551), beta-Tubulin (P04691), MAP-2A/B-3,MAP-2C-3, Stathmin-4, Dynamin-1 (P21575), Phocein, Dynactin (Q13561),Vimentin (P31000), Dynamin, Profilin, Cofilin 1,2; Somal Proteins:UCH-L1 (Q00981)-1, Glycogen phosphorylase-BB-2, PEBP (P31044), NSE(P07323), CK-BB (P07335), Thy 1.1, Prion protein, Huntingtin, 14-3-3proteins (e.g. 14-3-3-epsolon (P42655)), SM22-α, Calgranulin AB,alpha-Synuclein (P37377), beta-Synuclein (Q63754), HNP 22; Neuralnuclear proteins: NeuN-1, S/G(2) nuclear autoantigen (SG2NA),Huntingtin; Presynaptic Proteins: Synaptophysin-1, Synaptotagmin(P21707), Synaptojanin-1 (Q62910), Synaptojanin-2, Synapsin1(Synapsin-Ia), Synapsin2 (Q63537), Synapsin3, GAP43, Bassoon(NP_003449), Piccolo (aczonin) (NP_149015), Syntaxin, CRMP1, 2,Amphiphysin-1 (NP_001626), Amphiphysin-2 (NP_647477); Post-SynapticProteins: PSD95-1, NMDA-receptor (and all subtypes)-2, PSD93,AMPA-kainate receptor (all subtypes), mGluR (all subtypes), Calmodulindependent protein kinase II (CAMPK)-alpha, beta, gamma, CaMPK-IV,SNAP-25, a-/b-SNAP; Myelin-Oligodendrocyte: Myelin basic protein (MBP)and fragments, Myelin proteolipid protein (PLP), Myelin Oligodendrocytespecific protein (MOSP), Myelin Oligodendrocyte glycoprotein (MOG),myelin associated protein (MAG), Oligodendrocyte NS-1 protein; GlialProtein Biomarkers: GFAP (P47819), Protein disulfide isomerase(PDI)-P04785, Neurocalcin delta, S100beta; Microglia protein Biomarkers:Iba1, OX-42, OX-8, OX-6, ED-1, PTPase (CD45), CD40, CD68, CD11b,Fractalkine (CX3CL1) and Fractalkine receptor (CX3CR1), 5-d-4 antigen;Schwann cell markers: Schwann cell myelin protein; Glia Scar: Tenascin;Hippocampus: Stathmin, Hippocalcin, SCG10; Cerebellum: Purkinje cellprotein-2 (Pcp2), Calbindin D9K, Calbindin D28K (NP_114190), CerebellarCaBP, spot 35; Cerebrocortex: Cortexin-1 (P60606), H-2Z1 gene product;Thalamus: CD15 (3-fucosyl-N-acetyl-lactosamine) epitope; Hypothalamus:Orexin receptors (OX-1R and OX-2R)-appetite, Orexins(hypothalamus-specific peptides); Corpus callosum: MBP, MOG, PLP, MAG;Spinal Cord: Schwann cell myelin protein; Striatum: Striatin, Rhes (Rashomolog enriched in striatum); Peripheral ganglia: Gadd45a; Peripherialnerve fiber(sensory+motor): Peripherin, Peripheral myelin protein 22(AAH91499); Other Neuron-specific proteins: PH8 (S SerotonergicDopaminergic, PEP-19, Neurocalcin (NC), a neuron-specific EF-handCa²⁺-binding protein, Encephalopsin, Striatin, SG2NA, Zinedin,Recoverin, Visinin; Neurotransmitter Receptors: NMDA receptor subunits(e.g. NR1A2B), Glutamate receptor subunits (AMPA, Kainate receptors(e.g. GluR1, GluR4), beta-adrenoceptor subtypes (e.g. beta(2)),Alpha-adrenoceptors subtypes (e.g. alpha(2c)), GABA receptors (e.g.GABA(B)), Metabotropic glutamate receptor (e.g. mGluR3), 5-HT serotoninreceptors (e.g. 5-HT(3)), Dopamine receptors (e.g. D4), Muscarinic Achreceptors (e.g. M1), Nicotinic Acetylcholine Receptor (e.g. alpha-7);Neurotransmitter Transporters: Norepinephrine Transporter (NET),Dopamine transporter (DAT), Serotonin transporter (SERT), Vesiculartransporter proteins (VMAT1 and VMAT2), GABA transporter vesicularinhibitory amino acid transporter (VIAAT/VGAT), Glutamate Transporter(e.g. GLT1), Vesicular acetylcholine transporter, Vesicular GlutamateTransporter 1, [VGLUT1; BNPI] and VGLUT2, Choline transporter, (e.g.CHT1); Cholinergic Biomarkers: Acetylcholine Esterase, Cholineacetyltransferase [ChAT]; Dopaminergic Biomarkers: Tyrosine Hydroxylase(TH), Phospho-TH, DARPP32; Noradrenergic Biomarkers: Dopaminebeta-hydroxylase (DbH); Adrenergic Biomarkers: PhenylethanolamineN-methyltransferase (PNMT); Serotonergic Biomarkers: TryptophanHydroxylase (TrH); Glutamatergic Biomarkers: Glutaminase, Glutaminesynthetase; GABAergic Biomarkers: GABA transaminase [GABAT]), GABA-B-R2.

In another preferred embodiment the biomarkers are from at least two ormore proteins, peptides, variants or fragments thereof, such as thoseproteins listed in Table 1 below. For example, Axonal Proteins: α IIspectrin (and SPDB)-1, NF-68 (NF-L)-2, Tau-3, α II, III spectrin, NF-200(NF-H), NF-160 (NF-M), Amyloid precursor protein, α internexin;Dendritic Proteins: beta III-tubulin-1, p24 microtubule-associatedprotein-2, alpha-Tubulin (P02551), beta-Tubulin (P04691), MAP-2A/B-3,MAP-2C-3, Stathmin-4, Dynamin-1 (P21575), Phocein, Dynactin (Q13561),Vimentin (P31000), Dynamin, Profilin, Cofilin 1,2; Somal Proteins:UCH-L1 (Q00981)-1, Glycogen phosphorylase-BB-2, PEBP (P31044), NSE(P07323), CK-BB (P07335), Thy 1.1, Prion protein, Huntingtin, 14-3-3proteins (e.g. 14-3-3-epsolon (P42655)), SM22-α, Calgranulin AB,alpha-Synuclein (P37377), beta-Synuclein (Q63754), HNP 22; Neuralnuclear proteins: NeuN-1, S/G(2) nuclear autoantigen (SG2NA),Huntingtin; Presynaptic Proteins: Synaptophysin-1, Synaptotagmin(P21707), Synaptojanin-1 (Q62910), Synaptojanin-2, Synapsin1(Synapsin-Ia), Synapsin2 (Q63537), Synapsin3, GAP43, Bassoon(NP_003449),Piccolo (aczonin) (NP_149015), Syntaxin, CRMP1, 2, Amphiphysin-1(NP_001626), Amphiphysin-2 (NP_647477); Post-Synaptic Proteins: PSD95-1,NMDA-receptor (and all subtypes)-2, PSD93, AMPA-kainate receptor (allsubtypes), mGluR (all subtypes), Calmodulin dependent protein kinase II(CAMPK)-alpha, beta, gamma, CaMPK-IV, SNAP-25, a-/b-SNAP;Myelin-Oligodendrocyte: Myelin basic protein (MBP) and fragments, Myelinproteolipid protein (PLP), Myelin Oligodendrocyte specific protein(MOSP), Myelin Oligodendrocyte glycoprotein (MOG), myelin associatedprotein (MAG), Oligodendrocyte NS-1 protein; Glial Protein Biomarkers:GFAP (P47819), Protein disulfide isomerase (PDI)-P04785, Neurocalcindelta, S100beta; Microglia protein Biomarkers: Iba1, OX-42, OX-8, OX-6,ED-1, PTPase (CD45), CD40, CD68, CD11b, Fractalkine (CX3CL1) andFractalkine receptor (CX3CR1), 5-d-4 antigen; Schwann cell markers:Schwann cell myelin protein; Glia Scar: Tenascin; Hippocampus: Stathmin,Hippocalcin, SCG10; Cerebellum: Purkinje cell protein-2 (Pcp2),Calbindin D9K, Calbindin D28K (NP_114190), Cerebellar CaBP, spot 35;Cerebrocortex: Cortexin-1 (P60606), H-2Z1 gene product; Thalamus: CD15(3-fucosyl-N-acetyl-lactosamine) epitope; Hypothalamus: Orexin receptors(OX-1R and OX-2R)-appetite, Orexins (hypothalamus-specific peptides);Corpus callosum: MBP, MOG, PLP, MAG; Spinal Cord: Schwann cell myelinprotein; Striatum: Striatin, Rhes (Ras homolog enriched in striatum);Peripheral ganglia: Gadd45a; Peripherial nerve fiber(sensory+motor):Peripherin, Peripheral myelin protein 22 (AAH91499); OtherNeuron-specific proteins: PH8 (S Serotonergic Dopaminergic, PEP-19,Neurocalcin (NC), a neuron-specific EF-hand Ca²⁺-binding protein,Encephalopsin, Striatin, SG2NA, Zinedin, Recoverin, Visinin;Neurotransmitter Receptors: NMDA receptor subunits (e.g. NR1A2B),Glutamate receptor subunits (AMPA, Kainate receptors (e.g. GluR1,GluR4), beta-adrenoceptor subtypes (e.g. beta(2)), Alpha-adrenoceptorssubtypes (e.g. alpha(2c)), GABA receptors (e.g. GABA(B)), Metabotropicglutamate receptor (e.g. mGluR3), 5-HT serotonin receptors (e.g.5-HT(3)), Dopamine receptors (e.g. D4), Muscarinic Ach receptors (e.g.M1), Nicotinic Acetylcholine Receptor (e.g. alpha-7); NeurotransmitterTransporters: Norepinephrine Transporter (NET), Dopamine transporter(DAT), Serotonin transporter (SERT), Vesicular transporter proteins(VMAT1 and VMAT2), GABA transporter vesicular inhibitory amino acidtransporter (VIAAT/VGAT), Glutamate Transporter (e.g. GLT1), Vesicularacetylcholine transporter, Vesicular Glutamate Transporter 1, [VGLUT1;BNPI] and VGLUT2, Choline transporter, (e.g. CHT1); CholinergicBiomarkers: Acetylcholine Esterase, Choline acetyltransferase [ChAT];Dopaminergic Biomarkers: Tyrosine Hydroxylase (TH), Phospho-TH, DARPP32;Noradrenergic Biomarkers: Dopamine beta-hydroxylase (DbH); AdrenergicBiomarkers: Phenylethanolamine N-methyltransferase (PNMT); SerotonergicBiomarkers: Tryptophan Hydroxylase (TrH); Glutamatergic Biomarkers:Glutaminase, Glutamine synthetase; GABAergic Biomarkers: GABAtransaminase [GABAT]), GAB A-B-R2.

In another preferred embodiment, the biomarkers comprise at least onebiomarker from each neural cell type. The composition of biomarkers isdiagnostic of neural injury, damage and/or neural disorders. Thecomposition comprises: α II spectrin, SPDB-1, NF-68, NF-L-2, Tau-3,βIII-tubulin-1, p24 microtubule-associated protein-2, UCH-L1 (Q00981)-1,Glycogen phosphorylase-BB-2, NeuN-1, Synaptophysin-1, synaptotagmin(P21707), Synaptojanin-1 (Q62910), Synaptojanin-2, PSD95-1,NMDA-receptor-2 and subtypes, myelin basic protein (MBP) and fragments,GFAP (P47819), Iba1, OX-42, OX-8, OX-6, ED-1, Schwann cell myelinprotein, tenascin, stathmin, Purkinje cell protein-2 (Pcp2), Cortexin-1(P60606), Orexin receptors (OX-1R, OX-2R), Striatin, Gadd45a,Peripherin, peripheral myelin protein 22 (AAH91499), and Neurocalcin(NC).

In another preferred embodiment an expanded panel of biomarkers are usedto provide highly enriched information of mechanism of injury, modes ofcell death (necrosis versus apoptosis), sites of injury, sites andstatus of different cell types in the nervous system and enhanceddiagnosis (better selectivity and specificity). This invention is animportant and significant improvement over existing technologies focusedon small panel (e.g. a four-marker panel: -MBP-Thrombomodulin-S100B-NSEfrom Syn X Pharma (Mississauga, Canada)- or single markers (e.g. S100Bfrom DiaSorin (Sweden)).

In another preferred embodiment the biomarkers are selected todistinguish between different host anatomical regions. For example, atleast one biomarker can be selected from neural subcellular proteinbiomarkers, nervous system anatomical markers such as hippocampusprotein biomarkers and cerebellum protein biomarkers. Examples of neuralsubcellular protein biomarkers are NF-200, NF-160, NF-68. Examples ofhippocampus protein biomarkers are SCG10, stathmin. An example of acerebellum protein biomarker is Purkinje cell protein-2 (Pcp2).

In another preferred embodiment the biomarkers are selected todistinguish between injury at the cellular level, thereby detectingwhich cell type has been injured. For example at least one biomarkerprotein is selected from a representative panel of protein biomarkersspecific for that cell type. Examples for biomarkers specific for celltypes include myelin-oligodendrocyte biomarkers such as myelin basicprotein (MBP), myelin proteolipid protein (PLP), myelin oligodendrocytespecific protein (MOSP), oligodendrocyte NS-1 protein, myelinoligodendrocyte glycoprotein (MOG). Examples of biomarkers specific forSchwann cells include, but not limited to Schwann cell myelin protein.Examples of Glial cell protein biomarkers include, but not limited toGFAP (protein accession number P47819), protein disulfide isomerase(PDI)-P04785. Thus, by detecting one or more specific biomarkers thespecific cell types that have been injured can be determined.

In another preferred embodiment, biomarkers specific for differentsubcellular structures of a cell can be used to determine thesubcellular level of injury. Examples include but not limited to neuralsubcellular protein biomarkers such as, NF-200, NF-160, NF-68; dendriticbiomarkers such as for example, alpha-tubulin (P02551), beta-tubulin(P04691), MAP-2A/B, MAP-2C, Tau, Dynamin-1 (P212575), Phoecin, Dynactin(Q13561), p24 microtubule-associated protein, vimentin (P31000); somalproteins such as for example, UCH-L1 (Q00981), PEBP (P31044), NSE(P07323), CK-BB (P07335), Thy 1.1, prion protein, 14-3-3 proteins;neural nuclear proteins, such as for example S/G(2) nuclear autoantigen(SG2NA), NeuN. Thus, detection of specific biomarkers will determine theextent and subcellular location of injury.

In another preferred embodiment, biomarkers specific for differentanatomical regions, different cell types, and/or different subcellularstructures of a cell are selected to provide information as to thelocation of anatomical injury, the location of the injured cell type,and the location of injury at a subcellular level. Any number ofbiomarkers from each set can be used to provide highly enriched anddetailed information of mechanism, mode and subcellular sites of injury,anatomical locations of injury and status of different cell types in thenervous system (neuronal subtypes, neural stem cells, astro-glia,oligodendrocyte and microglia cell).

In a preferred embodiment at least one biomarker specific differentlocations such as for an anatomical region, different cell types and/ordifferent subcellular structures of a cell are used to determine themechanism, mode, subcellular sites of injury, anatomical locations ofinjury and status of different cell types in the nervous system, morepreferably a panel of at least 2 biomarkers are selected from eachdesired location, more preferably at least 3, 4, 5, 6, 7, 8, 9, 10 up toabout 100 biomarkers are selected from each location.

In a preferred embodiment, subcellular neuronal biomarkers for diagnosisand detection of brain and/or CNS injury and/or neural disorders,preferably are at least one of axonal proteins, dendritic proteins,somal proteins, neural nuclear proteins, presynaptic proteins,post-synaptic proteins.

In a preferred embodiment, axonal proteins identified as biomarkers fordiagnosis and detection of brain and/or CNS injury or neural disorders,preferably are: α II spectrin (and SPDB)-1, NF-68 (NF-L)-2, Tau-3, α II,III spectrin, NF-200 (NF-H), NF-160 (NF-M), Amyloid precursor protein, αinternexin, peptides, fragments or derivatives thereof.

In a preferred embodiment, dendritic proteins identified as biomarkersfor diagnosis and detection of brain and/or CNS injury or neuraldisorders, preferably are: beta III-tubulin-1, p24microtubule-associated protein-2, alpha-Tubulin (P02551), beta-Tubulin(P04691), MAP-2A/B-3, MAP-2C-3, Stathmin-4, Dynamin-1 (P21575), Phocein,Dynactin (Q13561), Vimentin (P31000), Dynamin, Profilin, Cofilin 1,2,peptides, fragments or derivatives thereof.

In another preferred embodiment, neural nuclear proteins identified asbiomarkers for diagnosis and detection of brain and/or CNS injury orneural disorders, preferably are: NeuN-1, S/G(2) nuclear autoantigen(SG2NA), Huntingtin, peptides or fragments thereof.

In another preferred embodiment, somal proteins identified as biomarkersfor diagnosis and detection of brain and/or CNS injury or neuraldisorders, preferably are: UCH-L1 (Q00981)-1, Glycogenphosphorylase-BB-2, PEBP (P31044), NSE (P07323), CK-BB (P07335), Thy1.1, Prion protein, Huntingtin, 14-3-3 proteins (e.g. 14-3-3-epsolon(P42655)), SM22-α, Calgranulin AB, alpha-Synuclein (P37377),beta-Synuclein (Q63754), HNP 22, peptides, fragments or derivativesthereof.

In another preferred embodiment, presynaptic proteins identified asbiomarkers for diagnosis and detection of brain and/or CNS injury orneural disorders, preferably are: Synaptophysin-1, Synaptotagmin(P21707), Synaptojanin-1 (Q62910), Synaptojanin-2, Synapsin1(Synapsin-Ia), Synapsin2 (Q63537), Synapsin3, GAP43, Bassoon(NP_003449),Piccolo (aczonin) (NP_149015), Syntaxin, CRMP1, 2, Amphiphysin-1(NP_001626), Amphiphysin-2 (NP_647477), peptides, fragments orderivatives thereof.

In another preferred embodiment, post-synaptic proteins identified asbiomarkers for diagnosis and detection of brain and/or CNS injury orneural disorders, preferably are: PSD95-1, NMDA-receptor (and allsubtypes)-2, PSD93, AMPA-kainate receptor (all subtypes), mGluR (allsubtypes), Calmodulin dependent protein kinase II (CAMPK)-alpha, beta,gamma, CaMPK-IV, SNAP-25, a-/b-SNAP, peptides, fragments or derivativesthereof.

In another preferred embodiment, identified biomarkers distinguish thedamaged neural cell subtype such as, for example,myelin-oligodendrocytes, glial, microglial, Schwann cells, glial scar.

In a preferred embodiment, Myelin-Oligodendrocyte biomarkers are: Myelinbasic protein (MBP) and fragments, Myelin proteolipid protein (PLP),Myelin Oligodendrocyte specific protein (MOSP), Myelin Oligodendrocyteglycoprotein (MOG), myelin associated protein (MAG), OligodendrocyteNS-1 protein; Glial Protein Biomarkers: GFAP (P47819), Protein disulfideisomerase (PDI)—P04785, Neurocalcin delta, S100beta; Microglia proteinBiomarkers: Iba1, OX-42, OX-8, OX-6, ED-1, PTPase (CD45), CD40, CD68,CD11b, Fractalkine (CX3CL1) and Fractalkine receptor (CX3CR1), 5-d-4antigen; Schwann cell markers: Schwann cell myelin protein; Glia Scar:Tenascin.

In another preferred embodiment, biomarkers identifying the anatomicallocation of neural injury and/or neural damage, include, but not limitedto: Hippocampus: Stathmin, Hippocalcin, SCG10; Cerebellum: Purkinje cellprotein-2 (Pcp2), Calbindin D9K, Calbindin D28K (NP_114190), CerebellarCaBP, spot 35; Cerebrocortex: Cortexin-1 (P60606), H-2Z1 gene product;Thalamus: CD15 (3-fucosyl-N-acetyl-lactosamine) epitope; Hypothalamus:Orexin receptors (OX-1R and OX-2R)-appetite, Orexins(hypothalamus-specific peptides); Corpus callosum: MBP, MOG, PLP, MAG;Spinal Cord: Schwann cell myelin protein; Striatum: Striatin, Rhes (Rashomolog enriched in striatum); Peripheral ganglia: Gadd45a; Peripherialnerve fiber(sensory+motor): Peripherin, Peripheral myelin protein 22(AAH91499); PH8 (S Serotonergic Dopaminergic), PEP-19, Neurocalcin (NC),a neuron-specific EF-hand Ca²⁺-binding protein, Encephalopsin, Striatin,SG2NA, Zinedin, Recoverin, and Visinin.

In another preferred embodiment, biomarkers identifying damaged neuralsubtypes include, but not limited to: Neurotransmitter Receptors: NMDAreceptor subunits (e.g. NR1A2B), Glutamate receptor subunits (AMPA,Kainate receptors (e.g. GluR1, GluR4), beta-adrenoceptor subtypes (e.g.beta(2)), Alpha-adrenoceptors subtypes (e.g. alpha(2c)), GABA receptors(e.g. GABA(B)), Metabotropic glutamate receptor (e.g. mGluR3), 5-HTserotonin receptors (e.g. 5-HT(3)), Dopamine receptors (e.g. D4),Muscarinic Ach receptors (e.g. M1), Nicotinic Acetylcholine Receptor(e.g. alpha-7); Neurotransmitter Transporters: NorepinephrineTransporter (NET), Dopamine transporter (DAT), Serotonin transporter(SERT), Vesicular transporter proteins (VMAT1 and VMAT2), GABAtransporter vesicular inhibitory amino acid transporter (VIAAT/VGAT),Glutamate Transporter (e.g. GLT1), Vesicular acetylcholine transporter,Vesicular Glutamate Transporter 1, [VGLUT1; BNPI] and VGLUT2, Cholinetransporter, (e.g. CHT1); Cholinergic Biomarkers: AcetylcholineEsterase, Choline acetyltransferase [ChAT]; Dopaminergic Biomarkers:Tyrosine Hydroxylase (TH), Phospho-TH, DARPP32; NoradrenergicBiomarkers: Dopamine beta-hydroxylase (DbH); Adrenergic Biomarkers:Phenylethanolamine N-methyltransferase (PNMT); Serotonergic Biomarkers:Tryptophan Hydroxylase (TrH); Glutamatergic Biomarkers: Glutaminase,Glutamine synthetase; GABAergic Biomarkers: GABA transaminase [GABAT]),GABA-B-R2.

Demyelination proteins identified as biomarkers for diagnosis anddetection of brain and/or CNS injury or neural disorders, preferablyare: myelin basic protein (MBP), myelin proteolipid protein, peptides,fragments or derivatives thereof.

In another preferred embodiment, glial proteins identified as biomarkersfor diagnosis and detection of brain and/or CNS injury or neuraldisorders, preferably are: GFAP (P47819), protein disulfide isomerase(PDI—P04785), peptides, fragments and derivatives thereof.

In another preferred embodiment, cholinergic proteins identified asbiomarkers for diagnosis and detection of brain and/or CNS injury orneural disorders, preferably are: acetylcholine esterase, cholineacetyltransferase, peptides, fragments or derivatives thereof.

In another preferred embodiment, dopaminergic proteins identified asbiomarkers for diagnosis and detection of brain and/or CNS injury orneural disorders, preferably are: tyrosine hydroxylase (TH), phospho-TH,DARPP32, peptides, fragments or derivatives thereof.

In another preferred embodiment, noradrenergic proteins identified asbiomarkers for diagnosis and detection of brain and/or CNS injury orneural disorders, preferably are: dopamine beta-hydroxylase (DbH),peptides, fragments or derivatives thereof.

In another preferred embodiment, serotonergic proteins identified asbiomarkers for diagnosis and detection of brain and/or CNS injury orneural disorders, preferably are: tryptophan hydroxylase (TrH),peptides, fragments or derivatives thereof.

In another preferred embodiment, glutamatergic proteins identified asbiomarkers for diagnosis and detection of brain and/or CNS injury orneural disorders, preferably are: glutaminase, glutamine synthetase,peptides, fragments or derivatives thereof.

In another preferred embodiment, GABAergic proteins identified asbiomarkers for diagnosis and detection of brain and/or CNS injury orneural disorders, preferably are: GABA transaminase(4-aminobutyrate-2-ketoglutarate transaminase [GABAT]), glutamic aciddecarboxylase (GAD25, 44, 65, 67), peptides, fragments and derivativesthereof.

In another preferred embodiment, neurotransmitter receptors identifiedas biomarkers for diagnosis and detection of brain and/or CNS injury orneural disorders, preferably are: beta-adrenoreceptor subtypes, (e.g.beta (2)), alpha-adrenoreceptor subtypes, (e.g. (alpha (2c)), GABAreceptors (e.g. GABA(B)), metabotropic glutamate receptor (e.g. mGluR3),NMDA receptor subunits (e.g. NR1A2B), Glutamate receptor subunits (e.g.GluR4), 5-HT serotonin receptors (e.g. 5-HT(3)), dopamine receptors(e.g. D4), muscarinic Ach receptors (e.g. M1), nicotinic acetylcholinereceptor (e.g. alpha-7), peptides, fragments or derivatives thereof.

In another preferred embodiment, neurotransmitter transportersidentified as biomarkers for diagnosis and detection of brain and/or CNSinjury or neural disorders, preferably are: norepinephrine transporter(NET), dopamine transporter (DAT), serotonin transporter (SERT),vesicular transporter proteins (VMAT1 and VMAT2), GABA transportervesicular inhibitory amino acid transporter (VIAAT/VGAT), glutamatetransporter (e.g. GLT1), vesicular acetylcholine transporter, cholinetransporter (e.g. CHT1), peptides, fragments, or derivatives thereof.

In another preferred embodiment, other proteins identified as biomarkersfor diagnosis and detection of brain and/or CNS injury or neuraldisorders, include, but are not limited to vimentin (P31000), CK-BB(P07335), 14-3-3-epsilon (P42655), MMP2, MMP9, peptides, fragments orderivatives thereof.

The markers are characterized by molecular weight, enzyme digestedfingerprints and by their known protein identities. The markers can beresolved from other proteins in a sample by using a variety offractionation techniques, e.g., chromatographic separation coupled withmass spectrometry, or by traditional immunoassays. In preferredembodiments, the method of resolution involves Surface-Enhanced LaserDesorption/Ionization (“SELDI”) mass spectrometry, in which the surfaceof the mass spectrometry probe comprises adsorbents that bind themarkers.

In other preferred embodiments, a plurality of the biomarkers aredetected, preferably at least two of the biomarkers are detected, morepreferably at least three of the biomarkers are detected, mostpreferably at least four of the biomarkers are detected.

In one aspect, the amount of each biomarker is measured in the subjectsample and the ratio of the amounts between the markers is determined.Preferably, the amount of each biomarker in the subject sample and theratio of the amounts between the biomarkers and compared to normalhealthy individuals. The increase in ratio of amounts of biomarkersbetween healthy individuals and individuals suffering from injury isindicative of the injury magnitude, disorder progression as compared toclinically relevant data.

Preferably, biomarkers that are detected at different stages of injuryand clinical disease are correlated to assess anatomical injury, type ofcellular injury, subcellular localization of injury. Monitoring of whichbiomarkers are detected at which stage, degree of injury in disease orphysical injury will provide panels of biomarkers that provide specificinformation on mechanisms of injury, identify multiple subcellular sitesof injury, identify multiple cell types involved in disease relatedinjury and identify the anatomical location of injury.

In another aspect, preferably a single biomarker is used in combinationwith one or more biomarkers from normal, healthy individuals fordiagnosing injury, location of injury and progression of disease and/orneural injury, more preferably a plurality of the markers are used incombination with one or more biomarkers from normal, healthy individualsfor diagnosing injury, location of injury and progression of diseaseand/or neural injury. It is preferred that one or more proteinbiomarkers are used in comparing protein profiles from patientssusceptible to, or suffering from disease and/or neural injury, withnormal subjects.

Preferred detection methods include use of a biochip array. Biochiparrays useful in the invention include protein and nucleic acid arrays.One or more markers are immobilized on the biochip array and subjectedto laser ionization to detect the molecular weight of the markers.Analysis of the markers is, for example, by molecular weight of the oneor more markers against a threshold intensity that is normalized againsttotal ion current. Preferably, logarithmic transformation is used forreducing peak intensity ranges to limit the number of markers detected.

In another preferred method, data is generated on immobilized subjectsamples on a biochip array, by subjecting said biochip array to laserionization and detecting intensity of signal for mass/charge ratio; and,transforming the data into computer readable form; and executing analgorithm that classifies the data according to user input parameters,for detecting signals that represent markers present in injured and/ordiseased patients and are lacking in non-injured and/or diseased subjectcontrols.

Preferably the biochip surfaces are, for example, ionic, anionic,comprised of immobilized nickel ions. comprised of a mixture of positiveand negative ions, comprises one or more antibodies, single or doublestranded nucleic acids, comprises proteins, peptides or fragmentsthereof, amino acid probes, comprises phage display libraries.

In other preferred methods one or more of the markers are detected usinglaser desorption/ionization mass spectrometry, comprising, providing aprobe adapted for use with a mass spectrometer comprising an adsorbentattached thereto, and; contacting the subject sample with the adsorbent,and; desorbing and ionizing the marker or markers from the probe anddetecting the deionized/ionized markers with the mass spectrometer.

Preferably, the laser desorption/ionization mass spectrometry comprises,providing a substrate comprising an adsorbent attached thereto;contacting the subject sample with the adsorbent; placing the substrateon a probe adapted for use with a mass spectrometer comprising anadsorbent attached thereto; and, desorbing and ionizing the marker ormarkers from the probe and detecting the desorbed/ionized marker ormarkers with the mass spectrometer.

The adsorbent can for example be, hydrophobic, hydrophilic, ionic ormetal chelate adsorbent, such as, nickel or an antibody, single- ordouble stranded oligonucleotide, amino acid, protein, peptide orfragments thereof.

In another embodiment, a process for purification of a biomarker,comprising fractioning a sample comprising one or more proteinbiomarkers by size-exclusion chromatography and collecting a fractionthat includes the one or more biomarker; and/or fractionating a samplecomprising the one or more biomarkers by anion exchange chromatographyand collecting a fraction that includes the one or more biomarkers.Fractionation is monitored for purity on normal phase and immobilizednickel arrays. Generating data on immobilized marker fractions on anarray, is accomplished by subjecting said array to laser ionization anddetecting intensity of signal for mass/charge ratio; and, transformingthe data into computer readable form; and executing an algorithm thatclassifies the data according to user input parameters, for detectingsignals that represent markers present in injured and/or diseasedpatients and are lacking in non-injured and/or diseased subjectcontrols. Preferably fractions are subjected to gel electrophoresis andcorrelated with data generated by mass spectrometry. In one aspect, gelbands representative of potential markers are excised and subjected toenzymatic treatment and are applied to biochip arrays for peptidemapping.

In another preferred embodiment, the presence of certain biomarkers isindicative of the extent of CNS and/or brain injury. For example,detection of one or more dendritic damage markers, soma injury markers,demyelination markers, axonal injury markers would be indicative of CNSinjury and the presence of one or more would be indicative of the extentof nerve injury.

In another preferred embodiment, the presence of certain biomarkers isindicative of a neurological disorder. i.e. dendritic damage markers,soma injury markers, demyelination markers, axonal injury markers,synaptic terminal markers, post-synaptic markers.

Preferred methods for detection and diagnosis of CNS/PNS and/or braininjury comprise detecting at least one or more protein biomarkers in asubject sample, and; correlating the detection of one or more proteinbiomarkers with a diagnosis of CNS and/or brain injury, wherein thecorrelation takes into account the detection of one or more biomarker ineach diagnosis, as compared to normal subjects, wherein the one or moreprotein markers are selected from: neural proteins, such as for example,Axonal Proteins: α II spectrin (and SPDB)-1, NF-68 (NF-L)-2, Tau-3, αII, III spectrin, NF-200 (NF-H), NF-160 (NF-M), Amyloid precursorprotein, α internexin; Dendritic Proteins: beta III-tubulin-1, p24microtubule-associated protein-2, alpha-Tubulin (P02551), beta-Tubulin(P04691), MAP-2A/B-3, MAP-2C-3, Stathmin-4, Dynamin-1 (P21575), Phocein,Dynactin (Q13561), Vimentin (P31000), Dynamin, Profilin, Cofilin 1,2;Somal Proteins: UCH-L1 (Q00981)-1, Glycogen phosphorylase-BB-2, PEBP(P31044), NSE (P07323), CK-BB (P07335), Thy 1.1, Prion protein,Huntingtin, 14-3-3 proteins (e.g. 14-3-3-epsolon (P42655)), SM22-α,Calgranulin AB, alpha-Synuclein (P37377), beta-Synuclein (Q63754), HNP22; Neural nuclear proteins: NeuN-1, S/G(2) nuclear autoantigen (SG2NA),Huntingtin; Presynaptic Proteins: Synaptophysin-1, Synaptotagmin(P21707), Synaptojanin-1 (Q62910), Synaptojanin-2, Synapsin1(Synapsin-Ia), Synapsin2 (Q63537), Synapsin3, GAP43, Bassoon(NP_003449),Piccolo (aczonin) (NP_149015), Syntaxin, CRMP1, 2, Amphiphysin-1(NP_001626), Amphiphysin-2 (NP_647477); Post-Synaptic Proteins: PSD95-1,NMDA-receptor (and all subtypes)-2, PSD93, AMPA-kainate receptor (allsubtypes), mGluR (all subtypes), Calmodulin dependent protein kinase II(CAMPK)-alpha, beta, gamma, CaMPK-IV, SNAP-25, a-/b-SNAP;Myelin-Oligodendrocyte: Myelin basic protein (MBP) and fragments, Myelinproteolipid protein (PLP), Myelin Oligodendrocyte specific protein(MOSP), Myelin Oligodendrocyte glycoprotein (MOG), myelin associatedprotein (MAG), Oligodendrocyte NS-1 protein; Glial Protein Biomarkers:GFAP (P47819), Protein disulfide isomerase (PDI)-P04785, Neurocalcindelta, S100beta; Microglia protein Biomarkers: Iba1, OX-42, OX-8, OX-6,ED-1, PTPase (CD45), CD40, CD68, CD11b, Fractalkine (CX3CL1) andFractalkine receptor (CX3CR1), 5-d-4 antigen; Schwann cell markers:Schwann cell myelin protein; Glia Scar: Tenascin; Hippocampus: Stathmin,Hippocalcin, SCG10; Cerebellum: Purkinje cell protein-2 (Pcp2),Calbindin D9K, Calbindin D28K (NP_114190), Cerebellar CaBP, spot 35;Cerebrocortex: Cortexin-1 (P60606), H-2Z1 gene product; Thalamus: CD15(3-fucosyl-N-acetyl-lactosamine) epitope; Hypothalamus: Orexin receptors(OX-1R and OX-2R)-appetite, Orexins (hypothalamus-specific peptides);Corpus callosum: MBP, MOG, PLP, MAG; Spinal Cord: Schwann cell myelinprotein; Striatum: Striatin, Rhes (Ras homolog enriched in striatum);Peripheral ganglia: Gadd45a; Peripherial nerve fiber(sensory+motor):Peripherin, Peripheral myelin protein 22 (AAH91499); OtherNeuron-specific proteins: PH8 (S Serotonergic Dopaminergic, PEP-19,Neurocalcin (NC), a neuron-specific EF-hand Ca²⁺-binding protein,Encephalopsin, Striatin, SG2NA, Zinedin, Recoverin, Visinin;Neurotransmitter Receptors: NMDA receptor subunits (e.g. NR1A2B),Glutamate receptor subunits (AMPA, Kainate receptors (e.g. GluR1,GluR4), beta-adrenoceptor subtypes (e.g. beta(2)), Alpha-adrenoceptorssubtypes (e.g. alpha(2c)), GABA receptors (e.g. GABA(B)), Metabotropicglutamate receptor (e.g. mGluR3), 5-HT serotonin receptors (e.g.5-HT(3)), Dopamine receptors (e.g. D4), Muscarinic Ach receptors (e.g.M1), Nicotinic Acetylcholine Receptor (e.g. alpha-7); NeurotransmitterTransporters: Norepinephrine Transporter (NET), Dopamine transporter(DAT), Serotonin transporter (SERT), Vesicular transporter proteins(VMAT1 and VMAT2), GABA transporter vesicular inhibitory amino acidtransporter (VIAAT/VGAT), Glutamate Transporter (e.g. GLT1), Vesicularacetylcholine transporter, Vesicular Glutamate Transporter 1, [VGLUT1;BNPI] and VGLUT2, Choline transporter, (e.g. CHT1); CholinergicBiomarkers: Acetylcholine Esterase, Choline acetyltransferase [ChAT];Dopaminergic Biomarkers: Tyrosine Hydroxylase (TH), Phospho-TH, DARPP32;Noradrenergic Biomarkers: Dopamine beta-hydroxylase (DbH); AdrenergicBiomarkers: Phenylethanolamine N-methyltransferase (PNMT); SerotonergicBiomarkers: Tryptophan Hydroxylase (TrH); Glutamatergic Biomarkers:Glutaminase, Glutamine synthetase; GABAergic Biomarkers: GABAtransaminase [GABAT]), GABA-B-R2.

In another preferred embodiment, the invention provides a kit foranalyzing cell damage in a subject. The kit, preferably includes: (a)one or more biomarkers (b) a substrate for holding a biological sampleisolated from a human subject suspected of having a damaged nerve cell,(c) an agent that specifically binds at least one or more of the neuralproteins; and (d) printed instructions for reacting the agent with thebiological sample or a portion of the biological sample to detect thepresence or amount of at least one marker in the biological sample. Thebiomarkers include but not limited to: Axonal Proteins: α II spectrin(and SPDB)-1, NF-68 (NF-L)-2, Tau-3, α II, III spectrin, NF-200 (NF-H),NF-160 (NF-M), Amyloid precursor protein, a internexin; DendriticProteins: beta III-tubulin-1, p24 microtubule-associated protein-2,alpha-Tubulin (P02551), beta-Tubulin (P04691), MAP-2A/B-3, MAP-2C-3,Stathmin-4, Dynamin-1 (P21575), Phocein, Dynactin (Q13561), Vimentin(P31000), Dynamin, Profilin, Cofilin 1,2; Somal Proteins: UCH-L1(Q00981)-1, Glycogen phosphorylase-BB-2, PEBP (P31044), NSE (P07323),CK-BB (P07335), Thy 1.1, Prion protein, Huntingtin, 14-3-3 proteins(e.g. 14-3-3-epsolon (P42655)), SM22-α, Calgranulin AB, alpha-Synuclein(P37377), beta-Synuclein (Q63754), HNP 22; Neural nuclear proteins:NeuN-1, S/G(2) nuclear autoantigen (SG2NA), Huntingtin; PresynapticProteins: Synaptophysin-1, Synaptotagmin (P21707), Synaptojanin-1(Q62910), Synaptojanin-2, Synapsin1 (Synapsin-Ia), Synapsin2 (Q63537),Synapsin3, GAP43, Bassoon(NP_003449), Piccolo (aczonin) (NP_149015),Syntaxin, CRMP1, 2, Amphiphysin-1 (NP_001626), Amphiphysin-2(NP_647477); Post-Synaptic Proteins: PSD95-1, NMDA-receptor (and allsubtypes)-2, PSD93, AMPA-kainate receptor (all subtypes), mGluR (allsubtypes), Calmodulin dependent protein kinase II (CAMPK)-alpha, beta,gamma, CaMPK-IV, SNAP-25, a-/b-SNAP; Myelin-Oligodendrocyte: Myelinbasic protein (MBP) and fragments, Myelin proteolipid protein (PLP),Myelin Oligodendrocyte specific protein (MOSP), Myelin Oligodendrocyteglycoprotein (MOG), myelin associated protein (MAG), OligodendrocyteNS-1 protein; Glial Protein Biomarkers: GFAP (P47819), Protein disulfideisomerase (PDI)-P04785, Neurocalcin delta, S100beta; Microglia proteinBiomarkers: Iba1, OX-42, OX-8, OX-6, ED-1, PTPase (CD45), CD40, CD68,CD11b, Fractalkine (CX3CL1) and Fractalkine receptor (CX3CR1), 5-d-4antigen; Schwann cell markers: Schwann cell myelin protein; Glia Scar:Tenascin; Hippocampus: Stathmin, Hippocalcin, SCG10; Cerebellum:Purkinje cell protein-2 (Pcp2), Calbindin D9K, Calbindin D28K(NP_114190), Cerebellar CaBP, spot 35; Cerebrocortex: Cortexin-1(P60606), H-2Z1 gene product; Thalamus: CD15(3-fucosyl-N-acetyl-lactosamine) epitope; Hypothalamus: Orexin receptors(OX-1R and OX-2R)-appetite, Orexins (hypothalamus-specific peptides);Corpus callosum: MBP, MOG, PLP, MAG; Spinal Cord: Schwann cell myelinprotein; Striatum: Striatin, Rhes (Ras homolog enriched in striatum);Peripheral ganglia: Gadd45a; Peripherial nerve fiber(sensory+motor):Peripherin, Peripheral myelin protein 22 (AAH91499); OtherNeuron-specific proteins: PH8 (S Serotonergic Dopaminergic, PEP-19,Neurocalcin (NC), a neuron-specific EF-hand Ca²⁺-binding protein,Encephalopsin, Striatin, SG2NA, Zinedin, Recoverin, Visinin;Neurotransmitter Receptors: NMDA receptor subunits (e.g. NR1A2B),Glutamate receptor subunits (AMPA, Kainate receptors (e.g. GluR1,GluR4), beta-adrenoceptor subtypes (e.g. beta(2)), Alpha-adrenoceptorssubtypes (e.g. alpha(2c)), GABA receptors (e.g. GABA(B)), Metabotropicglutamate receptor (e.g. mGluR3), 5-HT serotonin receptors (e.g.5-HT(3)), Dopamine receptors (e.g. D4), Muscarinic Ach receptors (e.g.M1), Nicotinic Acetylcholine Receptor (e.g. alpha-7); NeurotransmitterTransporters: Norepinephrine Transporter (NET), Dopamine transporter(DAT), Serotonin transporter (SERT), Vesicular transporter proteins(VMAT1 and VMAT2), GABA transporter vesicular inhibitory amino acidtransporter (VIAAT/VGAT), Glutamate Transporter (e.g. GLT1), Vesicularacetylcholine transporter, Vesicular Glutamate Transporter 1, [VGLUT1;BNPI] and VGLUT2, Choline transporter, (e.g. CHT1); CholinergicBiomarkers: Acetylcholine Esterase, Choline acetyltransferase [ChAT];Dopaminergic Biomarkers: Tyrosine Hydroxylase (TH), Phospho-TH, DARPP32;Noradrenergic Biomarkers: Dopamine beta-hydroxylase (DbH); AdrenergicBiomarkers: Phenylethanolamine N-methyltransferase (PNMT); SerotonergicBiomarkers: Tryptophan Hydroxylase (TrH); Glutamatergic Biomarkers:Glutaminase, Glutamine synthetase; GABAergic Biomarkers: GABAtransaminase [GABAT]), GABA-B-R2.

In another preferred embodiment, the kit comprises a composition orpanel of biomarkers comprises: α II spectrin, SPDB-1, NF-68, NF-L-2,Tau-3, βIII-tubulin-1, p24 microtubule-associated protein-2, UCH-L1(Q00981)-1, Glycogen phosphorylase-BB-2, NeuN-1, Synaptophysin-1,synaptotagmin (P21707), Synaptojanin-1 (Q62910), Synaptojanin-2,PSD95-1, NMDA-receptor-2 and subtypes, myelin basic protein (MBP) andfragments, GFAP (P47819), Iba1, OX-42, OX-8, OX-6, ED-1, Schwann cellmyelin protein, tenascin, stathmin, Purkinje cell protein-2 (Pcp2),Cortexin-1 (P60606), Orexin receptors (OX-1R, OX-2R), Striatin, Gadd45a,Peripherin, peripheral myelin protein 22 (AAH91499), and Neurocalcin(NC).

Preferably, the biological sample is a fluid in communication with thenervous system of the subject prior to being isolated from the subject;for example, CSF or blood, and the agent can be an antibody, aptamer, orother molecule that specifically binds at least one or more of theneural proteins. The kit can also include a detectable label such as oneconjugated to the agent, or one conjugated to a substance thatspecifically binds to the agent (e.g., a secondary antibody).

Other aspects of the invention are described infra.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention is pointed out with particularity in the appended claims.The above and further advantages of this invention may be betterunderstood by referring to the following description taken inconjunction with the accompanying drawings, in which:

FIG. 1 is a schematic illustration showing the fate of brain injurybiomarkers. The pathway of genesis of biomarkers from the brain to theeventual release of such biomarkers into biofluids, such as CSF, blood,urine, saliva, sweat etc. provide a opportunity for biomarker detectionwith low invasiveness.

FIG. 2 is a schematic illustration showing sources of brain injurybiomarkers from different cell types (neurons, astro-glia cells,Microglia cells, oligodendrocyte or Schwann cell) and from differentsubcellular structural structure of a neuron (dendrites, axons, cellbody, presynaptic terminal and postsynaptic density)

FIG. 3A is a Western Blot showing the detection and accumulation ofNovel brain-specific marker #1: UCH-L1 neural protein in CSF of rodentsafter experimental traumatic brain injury in rats.

FIG. 3B is a graph showing the elevation of Novel brain-specific marker#1: Ubiquitin C-terminal hydrolase L1 (UCH-L1) in rat CSF 48 h afterexperimental brain injury: craniotomy and controlled cortical impact(CCI)-induced brain injury when compared to CSF from naïve control rats.

FIG. 4A is a Western Blot showing the detection and accumulation ofNovel brain-specific marker #2: neuronal microtubule binding protein(p24) in CSF of rodents after experimental traumatic brain injury inrats.

FIG. 4B is a graph showing the elevation of Novel brain-specific marker#2: neuronal microtubule binding protein (p24) in rat CSF 48 h afterexperimental brain injury: craniotomy and controlled cortical impact(CCI)-induced brain injury when compared to CSF from naïve control rats.

FIG. 5A is a Western Blot showing the detection and accumulation ofNovel brain-specific marker #3: Neuronal protein α-synuclein in CSF ofrodents after experimental traumatic brain injury in rats.

FIG. 5B is a graph showing the elevation of Novel brain-specific marker#3: Neuronal protein α-synuclein in rat CSF 48 h after experimentalbrain injury: craniotomy and controlled cortical impact (CCI)-inducedbrain injury when compared to CSF from naïve control rats.

FIG. 6A is a Western Blot showing the detection and accumulation ofNeuronal biomarker #1 UCH-L1 levels are elevated in human CSF 24 h afterTBI.

FIG. 6B is a graph showing the elevation of Neuronal biomarker #1 UCH-L1levels are elevated in human CSF 24 h after traumatic brain injury, whencompared to CSF from neurological controls with no apparent braininjury.

FIG. 7A is a Western Blot showing the detection and accumulation ofNovel brain-specific marker #2: neuronal microtubule binding protein(p24) in human CSF after traumatic brain injury

FIG. 7B is a graph showing the elevation of Neuronal biomarker Novelbrain-specific marker #2: neuronal microtubule binding protein (p24) inhuman CSF 24 h after traumatic brain injury when compared to CSF fromneurological controls with no apparent brain injury.

FIG. 8A are the results from a quantitative SW ELISA for synaptophysinshowing the detection of Novel brain-specific marker #4: synaptophysinin rat CSF after traumatic brain injury when compared to CSF fromneurological controls with no apparent brain injury.

FIG. 8B is a graph showing the elevation of Neuronal biomarker Novelbrain-specific marker #2: neuronal microtubule binding protein (p24) inhuman CSF 24 h after traumatic brain injury when compared to CSF fromneurological controls with no apparent brain injury.

FIG. 9A is a graph showing the elevation of Novel brain-specific marker#1: Ubiquitin C-terminal hydrolase L1 (UCH-L1) as measure byquantitative sandwich ELISA with samples from human CSF and serum frompatients with severe traumatic brain injury

FIG. 9B is a graph showing the temporal changes measured by quantitativesandwich ELISA in levels of UCH-L1 measured in serum for a patient withsevere TBI. Serum samples were taken at the time the patient wasadmitted to the hospital (0d), and at 12 hours (1d), 48 hours (2d), 72hours (3d), and 120 hours (5d) after the time of injury.

FIG. 10A is a Western Blot showing detection and accumulation ofneurensin (p24) in cerebral spinal fluid (CSF) in human patients withbrain injury showing p24 accumulation and spectrin breakdown product(SPDP) 150 kDa and 145 kDa measured at 12, 30, 42, 48, 66, 78 and 84hours after injury compared to controls N5 and N6.

FIG. 10B is a graph showing densiometric quantification of CSF p24levels in CSF in human brain injured patients at 12, 30, 42, 48, 66, 78and 84 hours after injury compared to a control N.

FIG. 11A is a Western Blot showing neurensin (p24) biomarkerimmunoblotting detection in human serum using a centrifugingfiltration/concentration technique in molecular weight range of 30-50kDa fraction at 24 hours after injury; 1 shows human TBI CSF (7.5 ul); 2is human TBI serum (200 ul with MW kDa cutoff); 3 is human TBI serum(175 ul plus human 25 ul CSF); 4 is serum (10-30 kDa cut off); 5 isserum plus CSF (10-30 kDa cut off).

FIG. 11B is a graph showing densiometric quantification of serum p24levels. The same method applied to normal control serum samples showedno detection of p24 levels (level=0; data not shown). Serum was pooledfrom 2 human patients.

FIG. 12A is a graph showing alpha-synuclein biomarker elevation in humanTBI patient CSF detected by sandwich ELISA. Alpha-synuclein levels incontrol non-brain injured CSF were compared to TBI patient CSF samplescollected at different post injury time (T=enrollment) or 12, 24, 48,72, 96, 120 and 168 hours after injury.

FIG. 12B is a graph showing alpha-synuclein levels in normal control(non-brain injured) serum compared to TBI patient serum samplescollected at different post-injury times (T=E (enrollment) or 24, 72 and96 hr after injury and showed significant elevation compared to controlserum from uninjured patients.

DETAILED DESCRIPTION

The present invention identifies biomarkers that are diagnostic of nervecell injury and/or neuronal disorders. Detection of different biomarkersof the invention are also diagnostic of the degree of severity of nerveinjury, the cell(s) involved in the injury, and the subcellularlocalization of the injury. In particular, the invention employs a stepof correlating the presence or amount of one or more neural protein(s)with the severity and/or type of nerve cell injury. The amount of aneural protein, fragment or derivative thereof directly relates toseverity of nerve tissue injury as a more severe injury damages agreater number of nerve cells which in turn causes a larger amount ofneural protein(s) to accumulate in the biological sample (e.g., CSF).

Prior to setting forth the invention, it may be helpful to anunderstanding thereof to set forth definitions of certain terms thatwill be used hereinafter.

“Marker” in the context of the present invention refers to a polypeptide(of a particular apparent molecular weight) which is differentiallypresent in a sample taken from patients having neural injury and/orneuronal disorders as compared to a comparable sample taken from controlsubjects (e.g., a person with a negative diagnosis, normal or healthysubject).

“Complementary” in the context of the present invention refers todetection of at least two biomarkers, which when detected togetherprovides increased sensitivity and specificity as compared to detectionof one biomarker alone.

The phrase “differentially present” refers to differences in thequantity and/or the frequency of a marker present in a sample taken frompatients having for example, neural injury as compared to a controlsubject. For example, a marker can be a polypeptide which is present atan elevated level or at a decreased level in samples of patients withneural injury compared to samples of control subjects. Alternatively, amarker can be a polypeptide which is detected at a higher frequency orat a lower frequency in samples of patients compared to samples ofcontrol subjects. A marker can be differentially present in terms ofquantity, frequency or both.

A polypeptide is differentially present between the two samples if theamount of the polypeptide in one sample is statistically significantlydifferent from the amount of the polypeptide in the other sample. Forexample, a polypeptide is differentially present between the two samplesif it is present at least about 120%, at least about 130%, at leastabout 150%, at least about 180%, at least about 200%, at least about300%, at least about 500%, at least about 700%, at least about 900%, orat least about 1000% greater than it is present in the other sample, orif it is detectable in one sample and not detectable in the other.

Alternatively or additionally, a polypeptide is differentially presentbetween the two sets of samples if the frequency of detecting thepolypeptide in samples of patients' suffering from neural injury and/orneuronal disorders, is statistically significantly higher or lower thanin the control samples. For example, a polypeptide is differentiallypresent between the two sets of samples if it is detected at least about120%, at least about 130%, at least about 150%, at least about 180%, atleast about 200%, at least about 300%, at least about 500%, at leastabout 700%, at least about 900%, or at least about 1000% more frequentlyor less frequently observed in one set of samples than the other set ofsamples.

“Diagnostic” means identifying the presence or nature of a pathologiccondition. Diagnostic methods differ in their sensitivity andspecificity. The “sensitivity” of a diagnostic assay is the percentageof diseased individuals who test positive (percent of “true positives”).Diseased individuals not detected by the assay are “false negatives.”Subjects who are not diseased and who test negative in the assay, aretermed “true negatives.” The “specificity” of a diagnostic assay is 1minus the false positive rate, where the “false positive” rate isdefined as the proportion of those without the disease who testpositive. While a particular diagnostic method may not provide adefinitive diagnosis of a condition, it suffices if the method providesa positive indication that aids in diagnosis.

A “test amount” of a marker refers to an amount of a marker present in asample being tested. A test amount can be either in absolute amount(e.g., μg/ml) or a relative amount (e.g., relative intensity ofsignals).

A “diagnostic amount” of a marker refers to an amount of a marker in asubject's sample that is consistent with a diagnosis of neural injuryand/or neuronal disorder. A diagnostic amount can be either in absoluteamount (e.g., μg/ml) or a relative amount (e.g., relative intensity ofsignals).

A “control amount” of a marker can be any amount or a range of amountwhich is to be compared against a test amount of a marker. For example,a control amount of a marker can be the amount of a marker in a personwithout neural injury and/or neuronal disorder. A control amount can beeither in absolute amount (e.g., μg/ml) or a relative amount (e.g.,relative intensity of signals).

“Probe” refers to a device that is removably insertable into a gas phaseion spectrometer and comprises a substrate having a surface forpresenting a marker for detection. A probe can comprise a singlesubstrate or a plurality of substrates.

“Substrate” or “probe substrate” refers to a solid phase onto which anadsorbent can be provided (e.g., by attachment, deposition, etc.).

“Adsorbent” refers to any material capable of adsorbing a marker. Theterm “adsorbent” is used herein to refer both to a single material(“monoplex adsorbent”) (e.g., a compound or functional group) to whichthe marker is exposed, and to a plurality of different materials(“multiplex adsorbent”) to which the marker is exposed. The adsorbentmaterials in a multiplex adsorbent are referred to as “adsorbentspecies.” For example, an addressable location on a probe substrate cancomprise a multiplex adsorbent characterized by many different adsorbentspecies (e.g., anion exchange materials, metal chelators, orantibodies), having different binding characteristics. Substratematerial itself can also contribute to adsorbing a marker and may beconsidered part of an “adsorbent.”

“Adsorption” or “retention” refers to the detectable binding between anabsorbent and a marker either before or after washing with an eluant(selectivity threshold modifier) or a washing solution.

“Eluant” or “washing solution” refers to an agent that can be used tomediate adsorption of a marker to an adsorbent. Eluants and washingsolutions are also referred to as “selectivity threshold modifiers.”Eluants and washing solutions can be used to wash and remove unboundmaterials from the probe substrate surface.

“Resolve,” “resolution,” or “resolution of marker” refers to thedetection of at least one marker in a sample. Resolution includes thedetection of a plurality of markers in a sample by separation andsubsequent differential detection. Resolution does not require thecomplete separation of one or more markers from all other biomoleculesin a mixture. Rather, any separation that allows the distinction betweenat least one marker and other biomolecules suffices.

“Gas phase ion spectrometer” refers to an apparatus that measures aparameter which can be translated into mass-to-charge ratios of ionsformed when a sample is volatilized and ionized. Generally ions ofinterest bear a single charge, and mass-to-charge ratios are oftensimply referred to as mass. Gas phase ion spectrometers include, forexample, mass spectrometers, ion mobility spectrometers, and total ioncurrent measuring devices.

“Mass spectrometer” refers to a gas phase ion spectrometer that includesan inlet system, an ionization source, an ion optic assembly, a massanalyzer, and a detector.

“Laser desorption mass spectrometer” refers to a mass spectrometer whichuses laser as means to desorb, volatilize, and ionize an analyte.

“Detect” refers to identifying the presence, absence or amount of theobject to be detected.

The terms “polypeptide,” “peptide” and “protein” are usedinterchangeably herein to refer to a polymer of amino acid residues. Theterms apply to amino acid polymers in which one or more amino acidresidue is an analog or mimetic of a corresponding naturally occurringamino acid, as well as to naturally occurring amino acid polymers.Polypeptides can be modified, e.g., by the addition of carbohydrateresidues to form glycoproteins. The terms “polypeptide,” “peptide” and“protein” include glycoproteins, as well as non-glycoproteins.

“Detectable moiety” or a “label” refers to a composition detectable byspectroscopic, photochemical, biochemical, immunochemical, or chemicalmeans. For example, useful labels include ³²P, ³⁵S, fluorescent dyes,electron-dense reagents, enzymes (e.g., as commonly used in an ELISA),biotin-streptavidin, dioxigenin, haptens and proteins for which antiseraor monoclonal antibodies are available, or nucleic acid molecules with asequence complementary to a target. The detectable moiety oftengenerates a measurable signal, such as a radioactive, chromogenic, orfluorescent signal, that can be used to quantify the amount of bounddetectable moiety in a sample. Quantitation of the signal is achievedby, e.g., scintillation counting, densitometry, or flow cytometry.

“Antibody” refers to a polypeptide ligand substantially encoded by animmunoglobulin gene or immunoglobulin genes, or fragments thereof, whichspecifically binds and recognizes an epitope (e.g., an antigen). Therecognized immunoglobulin genes include the kappa and lambda light chainconstant region genes, the alpha, gamma, delta, epsilon and mu heavychain constant region genes, and the myriad immunoglobulin variableregion genes. Antibodies exist, e.g., as intact immunoglobulins or as anumber of well characterized fragments produced by digestion withvarious peptidases. This includes, e.g., Fab′ and F(ab)′₂ fragments. Theterm “antibody,” as used herein, also includes antibody fragments eitherproduced by the modification of whole antibodies or those synthesized denovo using recombinant DNA methodologies. It also includes polyclonalantibodies, monoclonal antibodies, chimeric antibodies, humanizedantibodies, or single chain antibodies. “Fc” portion of an antibodyrefers to that portion of an immunoglobulin heavy chain that comprisesone or more heavy chain constant region domains, CH₁, CH₂ and CH₃, butdoes not include the heavy chain variable region.

“Immunoassay” is an assay that uses an antibody to specifically bind anantigen (e.g., a marker). The immunoassay is characterized by the use ofspecific binding properties of a particular antibody to isolate, target,and/or quantify the antigen.

The phrase “specifically (or selectively) binds” to an antibody or“specifically (or selectively) immunoreactive with,” when referring to aprotein or peptide, refers to a binding reaction that is determinativeof the presence of the protein in a heterogeneous population of proteinsand other biologics. Thus, under designated immunoassay conditions, thespecified antibodies bind to a particular protein at least two times thebackground and do not substantially bind in a significant amount toother proteins present in the sample. Specific binding to an antibodyunder such conditions may require an antibody that is selected for itsspecificity for a particular protein. For example, polyclonal antibodiesraised to marker NF-200 from specific species such as rat, mouse, orhuman can be selected to obtain only those polyclonal antibodies thatare specifically immunoreactive with marker NF-200 and not with otherproteins, except for polymorphic variants and alleles of marker NF-200.This selection may be achieved by subtracting out antibodies thatcross-react with marker NF-200 molecules from other species. A varietyof immunoassay formats may be used to select antibodies specificallyimmunoreactive with a particular protein. For example, solid-phase ELISAimmunoassays are routinely used to select antibodies specificallyimmunoreactive with a protein (see, e.g., Harlow & Lane, Antibodies, ALaboratory Manual (1988), for a description of immunoassay formats andconditions that can be used to determine specific immunoreactivity).Typically a specific or selective reaction will be at least twicebackground signal or noise and more typically more than 10 to 100 timesbackground.

“Energy absorbing molecule” or “EAM” refers to a molecule that absorbsenergy from an ionization source in a mass spectrometer thereby aidingdesorption of analyte, such as a marker, from a probe surface. Dependingon the size and nature of the analyte, the energy absorbing molecule canbe optionally used. Energy absorbing molecules used in MALDI arefrequently referred to as “matrix.” Cinnamic acid derivatives, sinapinicacid (“SPA”), cyano hydroxy cinnamic acid (“CHCA”) and dihydroxybenzoicacid are frequently used as energy absorbing molecules in laserdesorption of bioorganic molecules.

“Sample” is used herein in its broadest sense. A sample comprisingpolynucleotides, polypeptides, peptides, antibodies and the like maycomprise a bodily fluid; a soluble fraction of a cell preparation, ormedia in which cells were grown; a chromosome, an organelle, or membraneisolated or extracted from a cell; genomic DNA, RNA, or cDNA,polypeptides, or peptides in solution or bound to a substrate; a cell; atissue; a tissue print; a fingerprint, skin or hair; and the like.

“Substantially purified” refers to nucleic acid molecules or proteinsthat are removed from their natural environment and are isolated orseparated, and are at least about 60% free, preferably about 75% free,and most preferably about 90% free, from other components with whichthey are naturally associated.

“Substrate” refers to any rigid or semi-rigid support to which nucleicacid molecules or proteins are bound and includes membranes, filters,chips, slides, wafers, fibers, magnetic or nonmagnetic beads, gels,capillaries or other tubing, plates, polymers, and microparticles with avariety of surface forms including wells, trenches, pins, channels andpores.

As used herein, the term “injury or neural injury” is intended toinclude a damage which directly or indirectly affects the normalfunctioning of the CNS. For example, the injury can be damage to retinalganglion cells; a traumatic brain injury; a stroke related injury; acerebral aneurism related injury; a spinal cord injury, includingmonoplegia, diplegia, paraplegia, hemiplegia and quadriplegia; aneuroproliferative disorder or neuropathic pain syndrome. Examples ofCNS injuries or disease include TBI, stroke, concussion (includingpost-concussion syndrome), cerebral ischemia, neurodegenerative diseasesof the brain such as Parkinson's disease, Dementia Pugilistica,Huntington's disease and Alzheimer's disease, Creutzfeldt-Jakob disease,brain injuries secondary to seizures which are induced by radiation,exposure to ionizing or iron plasma, nerve agents, cyanide, toxicconcentrations of oxygen, neurotoxicity due to CNS malaria or treatmentwith anti-malaria agents, trypanosomes, malarial pathogens, and otherCNS traumas.

As used herein, the term “stroke” is art recognized and is intended toinclude sudden diminution or loss of consciousness, sensation, andvoluntary motion caused by rapture or obstruction (e.g. by a blood clot)of an artery of the brain.

As used herein, the term “Traumatic Brain Injury” is art recognized andis intended to include the condition in which, a traumatic blow to thehead causes damage to the brain, often without penetrating the skull.Usually, the initial trauma can result in expanding hematoma,subarachnoid hemorrhage, cerebral edema, raised intracranial pressure(ICP), and cerebral hypoxia, which can, in turn, lead to severesecondary events due to low cerebral blood flow (CBF).

“Neural cells” as defined herein, are cells that reside in the brain,central and peripheral nerve systems, including, but not limited to,nerve cells, glial cell, oligodendrocyte, microglia cells or neural stemcells.

“Neuronal specific or neuronally enriched proteins” are defined herein,as proteins that are present in neural cells and not in non-neuronalcells, such as, for example, cardiomyocytes, myocytes, in skeletalmuscles, hepatocytes, kidney cells and cells in testis. Non-limitingexamples of neural proteins are shown in Table 1 below.

“Neural (neuronal) defects, disorders or diseases” as used herein refersto any neurological disorder, including but not limited toneurodegenerative disorders (Parkinson's; Alzheimer's) or autoimmunedisorders (multiple sclerosis) of the central nervous system; memoryloss; long term and short term memory disorders; learning disorders;autism, depression, benign forgetfulness, childhood learning disorders,close head injury, and attention deficit disorder; autoimmune disordersof the brain, neuronal reaction to viral infection; brain damage;depression; psychiatric disorders such as bi-polarism, schizophrenia andthe like; narcolepsy/sleep disorders(including circadian rhythmdisorders, insomnia and narcolepsy); severance of nerves or nervedamage; severance of the cerebrospinal nerve cord (CNS) and any damageto brain or nerve cells; neurological deficits associated with AIDS;tics (e.g. Giles de la Tourette's syndrome); Huntington's chorea,schizophrenia, traumatic brain injury, tinnitus, neuralgia, especiallytrigeminal neuralgia, neuropathic pain, inappropriate neuronal activityresulting in neurodysthesias in diseases such as diabetes, MS and motorneurone disease, ataxias, muscular rigidity (spasticity) andtemporomandibular joint dysfunction; Reward Deficiency Syndrome (RDS)behaviors in a subject.

As used herein, “RDS” behaviors are those behaviors that manifests asone or more behavioral disorders related to an individual's feeling ofwell-being with anxiety, anger or a craving for a substance. RDSbehaviors include, alcoholism, SUD, smoking, BMI or obesity,pathological gambling, carbohydrate bingeing, axis 11 diagnosis, SAB,ADD/ADHD, CD, TS, family history of SUD, and Obesity. All thesebehaviors, and others described herein as associated with RDS behaviorsor genes involved in the neurological pathways related to RDS, areincluded as RDS behaviors as part of this invention. Additionally, manyof the clinical terms used herein for many specific disorders that areRDS disorders are found in the Quick Reference to the DiagnosticCriteria From DSM-IV™, The American Psychiatric Association, Washington,D.C., 1994.

Affective disorders, including major depression, and the bipolar,manic-depressive illness, are characterized by changes in mood as theprimary clinical manifestation. Major depression is the most common ofthe significant mental illnesses, and it must be distinguishedclinically from periods of normal grief, sadness and disappointment, andthe related dysphoria or demoralization frequently associated withmedical illness. Depression is characterized by feelings of intensesadness, and despair, mental slowing and loss of concentration,pessimistic worry, agitation, and self-deprecation. Physical changes canalso occur, including insomnia, anorexia, and weight loss, decreasedenergy and libido, and disruption of hormonal circadian rhythms.

Mania, as well as depression, is characterized by changes in mood as theprimary symptom. Either of these two extremes of mood may be accompaniedby psychosis with disordered thought and delusional perceptions.Psychosis may have, as a secondary symptom, a change in mood, and it isthis overlap with depression that causes much confusion in diagnosis.Severe mood changes without psychosis frequently occur in depression andare often accompanied by anxiety.

Parkinson's disease, independent of a specific etiology, is a chronic,progressive central nervous system disorder which usually appearsinsidiously in the latter decades of life. The disease produces a slowlyincreasing disability in purposeful movement. It is characterized byfour major clinical features of tremor, bradykinesia, rigidity and adisturbance of posture. Often patients have an accompanying dementia. Inidiopathic Parkinsonism, there is usually a loss of cells in thesubstantia nigra, locus ceruleus, and other pigmented neurons of thebrain, and a decrease of dopamine content in nerve axon terminals ofcells projecting from the substantia nigra. The understanding thatParkinsonism is a syndrome of dopamine deficiency and the discovery oflevodopa as an important drug for the treatment of the disease were thelogical culmination of a series of related basic and clinicalobservations, which serves as the rationale for drug treatment.

As used herein, the term “schizophrenia” refers to a psychiatricdisorder that includes at least two of the following: delusions,hallucinations, disorganized speech, grossly disorganized or catatonicbehavior, or negative symptoms. (APA, 1994, Diagnostic and StatisticalManual of Mental Disorders (Fourth Edition), Washington, D.C.).

The term “Alzheimer's Disease” refers to a progressive mentaldeterioration manifested by memory loss, confusion and disorientationbeginning in late middle life and typically resulting in death in fiveto ten years. Pathologically, Alzheimer's Disease can be characterizedby thickening, conglutination, and distortion of the intracellularneurofibrils, neurofibrillary tangles and senile plaques composed ofgranular or filamentous argentophilic masses with an amyloid core.Methods for diagnosing Alzheimer's Disease are known in the art. Forexample, the National Institute of Neurological and CommunicativeDisorders and Stroke-Alzheimer's Disease and the Alzheimer's Disease andRelated Disorders Association (NINCDS-ADRDA) criteria can be used todiagnose Alzheimer's Disease (McKhann et al., 1984, Neurology34:939-944). The patient's cognitive function can be assessed by theAlzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog; Rosenet al., 1984, Am. J. Psychiatry 141:1356-1364).

As used herein, the term “autism” refers to a state of mentalintroversion characterized by morbid self-absorption, social failure,language delay, and stereotyped behavior.

As used herein, the term “depression” refers to a clinical syndrome thatincludes a persistent sad mood or loss of interest in activities, whichlasts for at least two weeks in the absence of treatment.

The term “benign forgetfulness,” as used herein, refers to a mildtendency to be unable to retrieve or recall information that was onceregistered, learned, and stored in memory (e.g., an inability toremember where one placed one's keys or parked one's car). Benignforgetfulness typically affects individuals after 40 years of age andcan be recognized by standard assessment instruments such as theWechsler Memory Scale (Russell, 1975, J. Consult Clin. Psychol.43:800-809).

As used herein, the term “childhood learning disorders” refers to animpaired ability to learn, as experienced by certain children.

The term “close head injury,” as used herein, refers to a clinicalcondition after head injury or trauma which condition can becharacterized by cognitive and memory impairment. Such a condition canbe diagnosed as “amnestic disorder due to a general medical condition”according to DSM-IV.

The term “attention deficit disorder,” as used herein, refers to adisorder that is most commonly exhibited by children and which can becharacterized by increased motor activity and a decreased attentionspan. Attention-deficit disorder (“ADD”) is a common behavioral learningdisorder in children which adversely affects school performance andfamily relationships. Symptoms and signs include hyperactivity (e.g.,ADDH and AD/HD, DSM-IV), impulsivity, emotional lability, motorincoordination and some perceptual difficulties. Treatment has includedpsychostimulants, which while effective are controversial, and may causetroubling side effects such as dysphoria, headache and growthretardation. Other drugs, including the tricyclic antidepressants,appear to improve attention, but may be less effective than thepsychostimulants.

As used herein, “subcellular localization” refers to defined subcellularstructures within a single nerve cell. These subcellularly definedstructures are matched with unique neural proteins derived from, forexample, dendritic, axonal, myelin sheath, presynaptic terminal andpostsynaptic locations as illustrated in FIG. 2. By monitoring therelease of proteins unique to each of these regions, one can thereforemonitor and define subcellular damage after brain injury. Furthermore,mature neurons are differentiated into dedicated subtype fusing aprimary neural transmitter such as cholinergic (nicotinic andmucarinic), glutamatergic, gabaergic, serotonergic, dopaminergic. Eachof this neuronal subtype express unique neural proteins such as thosededicated for the synthesis, metabolism and transporter and receptor ofeach unique neurotransmitter system (Table 1).

As used herein, a “pharmaceutically acceptable” component is one that issuitable for use with humans and/or animals without undue adverse sideeffects (such as toxicity, irritation, and allergic response)commensurate with a reasonable benefit/risk ratio.

The terms “patient” or “individual” are used interchangeably herein, andis meant a mammalian subject to be treated, with human patients beingpreferred. In some cases, the methods of the invention find use inexperimental animals, in veterinary application, and in the developmentof animal models for disease, including, but not limited to, rodentsincluding mice, rats, and hamsters; and primates.

As used herein, “ameliorated” or “treatment” refers to a symptom whichis approaches a normalized value, e.g., is less than 50% different froma normalized value, preferably is less than about 25% different from anormalized value, more preferably, is less than 10% different from anormalized value, and still more preferably, is not significantlydifferent from a normalized value as determined using routinestatistical tests. For example, amelioration or treatment of depressionincludes, for example, relief from the symptoms of depression whichinclude, but are not limited to changes in mood, feelings of intensesadness and despair, mental slowing, loss of concentration, pessimisticworry, agitation, and self-deprecation. Physical changes may also berelieved, including insomnia, anorexia and weight loss, decreased energyand libido, and the return of normal hormonal circadian rhythms. Anotherexample, when using the terms “treating Parkinson's disease” or“ameliorating” as used herein means relief from the symptoms ofParkinson's disease which include, but are not limited to tremor,bradykinesia, rigidity, and a disturbance of posture.

Protein Biomarkers

In a preferred embodiment, detection of one or more neural biomarkers isdiagnostic of neural damage and/or neuronal disease. Examples of neuralbiomarkers, include but are not limited to: neural proteins, such as forexample, axonal proteins—NF-200 (NF-H), NF-160 (NF-M), NF-68 (NF-L);amyloid precursor protein; dendritic proteins—alpha-tubulin (P02551),beta-tubulin (P0 4691), MAP-2A/B, MAP-2C, Tau, Dynamin-1 (P21575),Dynactin (Q13561), P24; somal proteins—UCH-L1 (Q00981), PEBP (P31044),NSE (P07323), Thy 1.1, Prion, Huntington; presynapticproteins—synapsin-1, synapsin-2, alpha-synuclein (p3′73′7′7),beta-synuclein (Q63754), GAP43, synaptophysin, synaptotagmin (P21707),syntaxin; post-synaptic proteins—PSD95, PSD93, NMDA-receptor (includingall subtypes); demyelination biomarkers-myelin basic protein (MBP),myelin proteolipid protein; glial proteins—GFAP (P47819), proteindisulfide isomerase (PDI-P04785); neurotransmitterbiomarkers-cholinergic biomarkers: acetylcholine esterase, cholineacetyltransferase; dopaminergic biomarkers-tyrosine hydroxylase (TH),phospho-TH, DARPP32; noradrenergic biomarkers-dopamine beta-hydroxylase(DbH); serotonergic biomarkers-tryptophan hydroxylase (TrH);glutamatergic biomarkers-glutaminase, glutamine synthetase; GABAergicbiomarkers-GABA transaminase (4-aminobutyrate-2-ketoglutaratetransaminase [GABAT]), glutamic acid decarboxylase (GAD25, 44, 65, 67);neurotransmitter receptors-beta-adrenoreceptor subtypes, (e.g. beta(2)), alpha-adrenoreceptor subtypes, (e.g. (alpha (2c)), GABA receptors(e.g. GABA(B)), metabotropic glutamate receptor (e.g. mGluR3), NMDAreceptor subunits (e.g. NR1A2B), Glutamate receptor subunits (e.g.GluR4), 5-HT serotonin receptors (e.g. 5-HT(3)), dopamine receptors(e.g. D4), muscarinic Ach receptors (e.g. M1), nicotinic acetylcholinereceptor (e.g. alpha-7); neurotransmitter transporters-norepinephrinetransporter (NET), dopamine transporter (DAT), serotonin transporter(SERT), vesicular transporter proteins (VMAT1 and VMAT2), GABAtransporter vesicular inhibitory amino acid transporter (VIAAT/VGAT),glutamate transporter (e.g. GLT1), vesicular acetylcholine transporter,choline transporter (e.g. CHT1); other protein biomarkers include, butnot limited to vimentin (P31000), CK-BB (P07335), 14-3-3-epsilon(P42655), MMP2, MMP9.

In another preferred embodiment, a composition or panel of biomarkerscomprises: Axonal Proteins: α II spectrin (and SPDB)-1, NF-68 (NF-L)-2,Tau-3, α II, III spectrin, NF-200 (NF-H), NF-160 (NF-M), Amyloidprecursor protein, α internexin; Dendritic Proteins: beta III-tubulin-1,p24 microtubule-associated protein-2, alpha-Tubulin (P02551),beta-Tubulin (P04691), MAP-2A/B-3, MAP-2C-3, Stathmin-4, Dynamin-1(P21575), Phocein, Dynactin (Q13561), Vimentin (P31000), Dynamin,Profilin, Cofilin 1,2; Somal Proteins: UCH-L1 (Q00981)-1, Glycogenphosphorylase-BB-2, PEBP (P31044), NSE (P07323), CK-BB (P07335), Thy1.1, Prion protein, Huntingtin, 14-3-3 proteins (e.g. 14-3-3-epsolon(P42655)), SM22-α, Calgranulin AB, alpha-Synuclein (P37377),beta-Synuclein (Q63754), HNP 22; Neural nuclear proteins: NeuN-1, S/G(2)nuclear autoantigen (SG2NA), Huntingtin; Presynaptic Proteins:Synaptophysin-1, Synaptotagmin (P21707), Synaptojanin-1 (Q62910),Synaptojanin-2, Synapsin1 (Synapsin-Ia), Synapsin2 (Q63537), Synapsin3,GAP43, Bassoon(NP_003449), Piccolo (aczonin) (NP_149015), Syntaxin,CRMP1, 2, Amphiphysin-1 (NP_001626), Amphiphysin-2 (NP_647477);Post-Synaptic Proteins: PSD95-1, NMDA-receptor (and all subtypes)-2,PSD93, AMPA-kainate receptor (all subtypes), mGluR (all subtypes),Calmodulin dependent protein kinase II (CAMPK)-alpha, beta, gamma,CaMPK-IV, SNAP-25, a-/b-SNAP; Myelin-Oligodendrocyte: Myelin basicprotein (MBP) and fragments, Myelin proteolipid protein (PLP), MyelinOligodendrocyte specific protein (MOSP), Myelin Oligodendrocyteglycoprotein (MOG), myelin associated protein (MAG), OligodendrocyteNS-1 protein; Glial Protein Biomarkers: GFAP (P47819), Protein disulfideisomerase (PDI)-P04785, Neurocalcin delta, S100beta; Microglia proteinBiomarkers: Iba1, OX-42, OX-8, OX-6, ED-1, PTPase (CD45), CD40, CD68,CD11b, Fractalkine (CX3CL1) and Fractalkine receptor (CX3CR1), 5-d-4antigen; Schwann cell markers: Schwann cell myelin protein; Glia Scar:Tenascin; Hippocampus: Stathmin, Hippocalcin, SCG10; Cerebellum:Purkinje cell protein-2 (Pcp2), Calbindin D9K, Calbindin D28K(NP_114190), Cerebellar CaBP, spot 35; Cerebrocortex: Cortexin-1(P60606), H-2Z1 gene product; Thalamus: CD15(3-fucosyl-N-acetyl-lactosamine) epitope; Hypothalamus: Orexin receptors(OX-1R and OX-2R)-appetite, Orexins (hypothalamus-specific peptides);Corpus callosum: MBP, MOG, PLP, MAG; Spinal Cord: Schwann cell myelinprotein; Striatum: Striatin, Rhes (Ras homolog enriched in striatum);Peripheral ganglia: Gadd45a; Peripherial nerve fiber(sensory+motor):Peripherin, Peripheral myelin protein 22 (AAH91499); OtherNeuron-specific proteins: PH8 (S Serotonergic Dopaminergic, PEP-19,Neurocalcin (NC), a neuron-specific EF-hand Ca²⁺-binding protein,Encephalopsin, Striatin, SG2NA, Zinedin, Recoverin, Visinin;Neurotransmitter Receptors: NMDA receptor subunits (e.g. NR1A2B),Glutamate receptor subunits (AMPA, Kainate receptors (e.g. GluR1,GluR4), beta-adrenoceptor subtypes (e.g. beta(2)), Alpha-adrenoceptorssubtypes (e.g. alpha(2c)), GABA receptors (e.g. GABA(B)), Metabotropicglutamate receptor (e.g. mGluR3), 5-HT serotonin receptors (e.g.5-HT(3)), Dopamine receptors (e.g. D4), Muscarinic Ach receptors (e.g.M1), Nicotinic Acetylcholine Receptor (e.g. alpha-7); NeurotransmitterTransporters: Norepinephrine Transporter (NET), Dopamine transporter(DAT), Serotonin transporter (SERT), Vesicular transporter proteins(VMAT1 and VMAT2), GABA transporter vesicular inhibitory amino acidtransporter (VIAAT/VGAT), Glutamate Transporter (e.g. GLT1), Vesicularacetylcholine transporter, Vesicular Glutamate Transporter 1, [VGLUT1;BNPI] and VGLUT2, Choline transporter, (e.g. CHT1); CholinergicBiomarkers: Acetylcholine Esterase, Choline acetyltransferase [ChAT];Dopaminergic Biomarkers: Tyrosine Hydroxylase (TH), Phospho-TH, DARPP32;Noradrenergic Biomarkers: Dopamine beta-hydroxylase (DbH); AdrenergicBiomarkers: Phenylethanolamine N-methyltransferase (PNMT); SerotonergicBiomarkers: Tryptophan Hydroxylase (TrH); Glutamatergic Biomarkers:Glutaminase, Glutamine synthetase; GABAergic Biomarkers: GABAtransaminase [GABAT]), GAB A-B-R2.

In another preferred embodiment, the panel of biomarkers comprise atleast one biomarker from each neural cell type. The composition ofbiomarkers is diagnostic of neural injury, damage and/or neuraldisorders. The composition comprises: α II spectrin, SPDB-1, NF-68,NF-L-2, Tau-3, βIII-tubulin-1, p24 microtubule-associated protein-2,UCH-L1 (Q00981)-1, Glycogen phosphorylase-BB-2, NeuN-1, Synaptophysin-1,synaptotagmin (P21707), Synaptojanin-1 (Q62910), Synaptojanin-2,PSD95-1, NMDA-receptor-2 and subtypes, myelin basic protein (MBP) andfragments, GFAP (P47819), Iba1, OX-42, OX-8, OX-6, ED-1, Schwann cellmyelin protein, tenascin, stathmin, Purkinje cell protein-2 (Pcp2),Cortexin-1 (P60606), Orexin receptors (OX-1R, OX-2R), Striatin, Gadd45a,Peripherin, peripheral myelin protein 22 (AAH91499), and Neurocalcin(NC).

Without wishing to be bound by theory, upon injury, structural andfunctional integrity of the cell membrane and blood brain barrier arecompromised. Brain-specific and brain-enriched proteins are releasedinto the extracellular space and subsequently into the CSF and blood.This is shown in a schematic illustration in FIG. 1.

In a preferred embodiment, detection of at least one neural protein inCSF, blood, or other biological fluids, is diagnostic of the severity ofbrain injury and/or the monitoring of the progression of therapy.Preferably, the neural proteins are detected during the early stages ofinjury. An increase in the amount of neural proteins, fragments orderivatives thereof, in a patient suffering from a neural injury,neuronal disorder as compared to a normal healthy individual, will bediagnostic of a neural injury and/or neuronal disorder.

In another preferred embodiment, detection of at least one neuralprotein in CSF, blood, or other biological fluids, is diagnostic of theseverity of injury following a variety of CNS insults, such as forexample, stroke, spinal cord injury, or neurotoxicity caused by alcoholor substance abuse (e.g. ecstacy, methamphetamine, etc.)

In a preferred embodiment, biomarkers of brain injury, neural injuryand/or neural disorders comprises proteins from the neural system (CNSand PNS). The CNS comprises many brain-specific and brain-enrichedproteins that are preferable biomarkers in the diagnosis of braininjury, neural injury, neural disorders and the like. Non-limitingexamples are shown in Table 1 and FIG. 2. For example, the neuralspecific biomarkers can include Axonal Proteins: α II spectrin (andSPDB)-1, NF-68 (NF-L)-2, Tau-3, α II, III spectrin, NF-200 (NF-H),NF-160 (NF-M), Amyloid precursor protein, α internexin; DendriticProteins: beta III-tubulin-1, p24 microtubule-associated protein-2,alpha-Tubulin (P02551), beta-Tubulin (P04691), MAP-2A/B-3, MAP-2C-3,Stathmin-4, Dynamin-1 (P21575), Phocein, Dynactin (Q13561), Vimentin(P31000), Dynamin, Profilin, Cofilin 1,2; Somal Proteins: UCH-L1(Q00981)-1, Glycogen phosphorylase-BB-2, PEBP (P31044), NSE (P07323),CK-BB (P07335), Thy 1.1, Prion protein, Huntingtin, 14-3-3 proteins(e.g. 14-3-3-epsolon (P42655)), SM22-α, Calgranulin AB, alpha-Synuclein(P37377), beta-Synuclein (Q63754), HNP 22; Neural nuclear proteins:NeuN-1, S/G(2) nuclear autoantigen (SG2NA), Huntingtin; PresynapticProteins: Synaptophysin-1, Synaptotagmin (P21707), Synaptojanin-1(Q62910), Synaptojanin-2, Synapsin 1 (Synapsin-Ia), Synapsin2 (Q63537),Synapsin3, GAP43, Bassoon(NP_003449), Piccolo (aczonin) (NP_149015),Syntaxin, CRMP1, 2, Amphiphysin-1 (NP_001626), Amphiphysin-2(NP_647477); Post-Synaptic Proteins: PSD95-1, NMDA-receptor (and allsubtypes)-2, PSD93, AMPA-kainate receptor (all subtypes), mGluR (allsubtypes), Calmodulin dependent protein kinase II (CAMPK)-alpha, beta,gamma, CaMPK-IV, SNAP-25, a-/b-SNAP; Myelin-Oligodendrocyte: Myelinbasic protein (MBP) and fragments, Myelin proteolipid protein (PLP),Myelin Oligodendrocyte specific protein (MOSP), Myelin Oligodendrocyteglycoprotein (MOG), myelin associated protein (MAG), OligodendrocyteNS-1 protein; Glial Protein Biomarkers: GFAP (P47819), Protein disulfideisomerase (PDI)-P04785, Neurocalcin delta, S100beta; Microglia proteinBiomarkers: Iba1, OX-42, OX-8, OX-6, ED-1, PTPase (CD45), CD40, CD68,CD11b, Fractalkine (CX3CL1) and Fractalkine receptor (CX3CR1), 5-d-4antigen; Schwann cell markers: Schwann cell myelin protein; Glia Scar:Tenascin; Hippocampus: Stathmin, Hippocalcin, SCG10; Cerebellum:Purkinje cell protein-2 (Pcp2), Calbindin D9K, Calbindin D28K(NP_114190), Cerebellar CaBP, spot 35; Cerebrocortex: Cortexin-1(P60606), H-2Z1 gene product; Thalamus: CD15(3-fucosyl-N-acetyl-lactosamine) epitope; Hypothalamus: Orexin receptors(OX-1R and OX-2R)-appetite, Orexins (hypothalamus-specific peptides);Corpus callosum: MBP, MOG, PLP, MAG; Spinal Cord: Schwann cell myelinprotein; Striatum: Striatin, Rhes (Ras homolog enriched in striatum);Peripheral ganglia: Gadd45a; Peripherial nerve fiber(sensory+motor):Peripherin, Peripheral myelin protein 22 (AAH91499); OtherNeuron-specific proteins: PH8 (S Serotonergic Dopaminergic, PEP-19,Neurocalcin (NC), a neuron-specific EF-hand Ca²⁺-binding protein,Encephalopsin, Striatin, SG2NA, Zinedin, Recoverin, Visinin;Neurotransmitter Receptors: NMDA receptor subunits (e.g. NR1A2B),Glutamate receptor subunits (AMPA, Kainate receptors (e.g. GluR1,GluR4), beta-adrenoceptor subtypes (e.g. beta(2)), Alpha-adrenoceptorssubtypes (e.g. alpha(2c)), GABA receptors (e.g. GABA(B)), Metabotropicglutamate receptor (e.g. mGluR3), 5-HT serotonin receptors (e.g.5-HT(3)), Dopamine receptors (e.g. D4), Muscarinic Ach receptors (e.g.M1), Nicotinic Acetylcholine Receptor (e.g. alpha-7); NeurotransmitterTransporters: Norepinephrine Transporter (NET), Dopamine transporter(DAT), Serotonin transporter (SERT), Vesicular transporter proteins(VMAT1 and VMAT2), GABA transporter vesicular inhibitory amino acidtransporter (VIAAT/VGAT), Glutamate Transporter (e.g. GLT1), Vesicularacetylcholine transporter, Vesicular Glutamate Transporter 1, [VGLUT1;BNPI] and VGLUT2, Choline transporter, (e.g. CHT1); CholinergicBiomarkers: Acetylcholine Esterase, Choline acetyltransferase [ChAT];Dopaminergic Biomarkers: Tyrosine Hydroxylase (TH), Phospho-TH, DARPP32;Noradrenergic Biomarkers: Dopamine beta-hydroxylase (DbH); AdrenergicBiomarkers: Phenylethanolamine N-methyltransferase (PNMT); SerotonergicBiomarkers: Tryptophan Hydroxylase (TrH); Glutamatergic Biomarkers:Glutaminase, Glutamine synthetase; GABAergic Biomarkers: GABAtransaminase [GABAT]), GABA-B-R2. Furthermore, proteins such as GFAP andprotein disulfide isomerase (PDI) are only synthesized in glial cells ofthe CNS, a feature that is used to further detect and diagnose theextent of damage to the CNS.

In another preferred embodiment, the invention provides for thequantitative detection of damage to the CNS, PNS and/or brain injury ata subcellular level. Depending on the type and severity of injury,neurons can undergo damage in specific cellular regions. For example,detection of certain biomarkers, such as for example, axonal proteins,fragments and derivatives thereof include, but not limited to: NF-200(NF-H), NF-160 (NF-M), NF-68 (NF-L), and the like, differentiatesbetween axonal versus dendritic damage. Non-limiting examples ofdendritic proteins, peptides, fragments and derivatives thereof,include, but not limited to: alpha-tubulin (P02551), beta-tubulin (P04691), MAP-2A/B, MAP-2C, Tau, Dynamin-1 (P21575), Dynactin (Q13561), p24(neural-specific MAP). Furthermore, detection of different biomarkersnot only differentiate between, for example, axonal or dendritic damage,but allow for the assessment of synaptic pathology, specific injury toelements of the pre-synaptic terminal and post-synaptic density. Seetable 1 for examples of biomarkers from each cellular, sub-cellular andanatomical locations, detection of which detects the location of injury.

In a preferred embodiment, biomarkers indicative of neural injury indifferent anatomical in vivo locations include but not limited to:Hippocampus: Stathmin, Hippocalcin, SCG10; Cerebellum: Purkinje cellprotein-2 (Pcp2), Calbindin D9K, Calbindin D28K (NP_114190), CerebellarCaBP, spot 35; Cerebrocortex: Cortexin-1 (P60606), H-2Z1 gene product;Thalamus: CD15 (3-fucosyl-N-acetyl-lactosamine) epitope; Hypothalamus:Orexin receptors (OX-1R and OX-2R)-appetite, Orexins(hypothalamus-specific peptides); Corpus callosum: MBP, MOG, PLP, MAG;Spinal Cord: Schwann cell myelin protein; Striatum: Striatin, Rhes (Rashomolog enriched in striatum); Peripheral ganglia: Gadd45a; Peripherialnerve fiber(sensory+motor): Peripherin, Peripheral myelin protein 22(AAH91499); Other Neuron-specific proteins: PH8 (S SerotonergicDopaminergic, PEP-19, Neurocalcin (NC), a neuron-specific EF-handCa²⁺-binding protein, Encephalopsin, Striatin, SG2NA, Zinedin,Recoverin, Visinin. For example, to determine injury in a certainanatomical location, detection of Stathmin and/or Hippocalcin and/orSCG10 is diagnostic of injury in the Hippocampus. Detection of Purkinjecell protein-2 (Pcp2) and/or Calbindin D9K and/or Calbindin D28K(NP_114190) and/or Cerebellar CaBP, spot 35 is diagnostic of injury inthe cerebellum. Detection of a combination of biomarkers, such asStathmin and/or Hippocalcin and/or SCG10 Purkinje cell protein-2 (Pcp2)and/or Calbindin D9K and/or Calbindin D28K (NP_114190) and/or CerebellarCaBP, spot 35 is diagnostic of injury in the Hippocampus and cerebellum.Therefore, detection of one or more or combinations of biomarkers isdiagnostic of the location of neural injury.

In another preferred embodiment, the amount of marker detected, forexample, in μg/ml is diagnostic of the extent of damage or injury.Quantitation of each biomarker is described in the specification and inthe Examples to follow. Assays include immunoassays (such as ELISA's),spectrophotometry, HPLC, SELDI, biochips and the like. Therefore, if forexample, 10 μg/ml of stathmin and 0.001 μg/ml of CaBP is diagnostic thatthe main injury is to the Hippocampus with some injury to thecerebellum. Detection of biomarkers from subcellular locations isdiagnostic of which cells are injured. For example, detection of axonalbiomarkers vs. dendritic biomarkers vs. microglial biomarkers isdiagnostic of the type of cells injured. As discussed, infra, thequantitation of each as compared to a normal individual is diagnostic ofthe extent of injury.

In another preferred embodiment, detection of certain biomarkers arediagnostic of the specific cell type affected following injury sinceneurons and glia possess distinct proteins. For example, detection ofglial proteins, peptides, fragments and derivatives thereof isdiagnostic of glial cell damage. Examples of glial proteins, include,but not limited to: GFAP (P47819), Protein disulfide isomerase(PDI)—P04785, Neurocalcin delta, S100beta.

The ability to detect and monitor levels of these proteins after CNSinjury provides enhanced diagnostic capability by allowing clinicians(1) to determine the level of injury severity in patients with variousCNS injuries, (2) to monitor patients for signs of secondary CNSinjuries that may elicit these cellular changes and (3) to monitor theeffects of therapy by examination of these proteins in CSF or blood.Unlike other organ-based diseases where rapid diagnostics for surrogatebiomarkers prove invaluable to the course of action taken to treat thedisease, no such rapid, definitive diagnostic tests exist for traumaticor ischemic brain injury that might provide physicians with quantifiableneurochemical markers to help determine the seriousness of the injury,the anatomical and cellular pathology of the injury, and theimplementation of appropriate medical management and treatment.

In an illustrative example, not meant to limit or construe the inventionin any way, identification of which brain-specific and brain-enrichedproteins are elevated in CSF following traumatic brain injury (TBI) isdiagnostic, for example, of brain injury, the degree of brain injury,type of cellular damage and degree of cellular damage. Furthermore,detection of certain brain-specific and brain-enriched proteins,fragments and derivatives thereof, is diagnostic of the type and degreeof cellular damage. For example, increased levels of a variety ofbrain-specific and brain-enriched proteins in the CSF 48 hours followinginjury, were detected. Specifically, elevated levels of the somalprotein ubiquitin C-terminal hydrolase L1 (UCH-L1) the dendritic proteinp24, and α-synuclein, a pre-synaptic protein were detected followinginjury.

In comparison to currently existing products, the invention providesseveral superior advantages and benefits. First, the identification ofneuronal biomarkers provide more rapid and less expensive diagnosis ofinjury severity than existing diagnostic devices such as computedtomography (CT) and magnetic resonance imaging (MM). The invention alsoallows quantitative detection and high content assessment of damage tothe CNS at a subcellular level (i.e. axonal versus dendritic). Theinvention also allows identification of the specific cell type affected(for example, neurons versus glia). In addition, levels of thesebrain-specific and brain-enriched proteins provides more accurateinformation regarding the level of injury severity than what is on themarket.

In another preferred embodiment, nerve cell damage in a subject isanalyzed by (a) providing a biological sample isolated from a subjectsuspected of having a damaged nerve cell; (b) detecting in the samplethe presence or amount of at least one marker selected from one or moreneural proteins; and (c) correlating the presence or amount of themarker with the presence or type of nerve cell damage in the subject.Preferably, neural cells, such as those cells that reside in the centraland peripheral nerve systems, including nerve cells, glial cell,oligodendrocyte, microglia cells or neural stem cells) in in vitroculture or in situ in an animal subjects express higher levels of neuralproteins (“neuronal specific or neuronally enriched” proteins; examplesare outlined in Table 1) as compared to non-neuronal cells, such ascardiomyocytes, myocytes in skeletal muscles, hepatocytes, kidney cellsand cells in testis. Preferably, the samples comprise neural cells, forexample, a biopsy of a central nervous system or peripheral nervoussystem tissue are suitable biological samples for use in the invention.In addition, after injury to the nervous system (such as brain injury),the neural cell membrane is compromised, leading to the efflux of theseneural proteins first into the extracellular fluid or space and to thecerebrospinal fluid and eventually in the circulating blood (as assistedby the compromised blood brain barrier) and other biofluids (e.g. urine,sweat, s saliva, etc.). Thus, other suitable biological samples include,but not limited to such cells or fluid secreted from these cells.Obtaining biological fluids such as cerebrospinal fluid, blood, plasma,serum, saliva and urine, from a subject is typically much less invasiveand traumatizing than obtaining a solid tissue biopsy sample. Thus,samples, which are biological fluids, are preferred for use in theinvention. CSF, in particular, is preferred for detecting nerve damagein a subject as it is in immediate contact with the nervous system andis readily obtainable.

In a preferred embodiment, detection of nerve cell damage comprisesdetection of one or more biomarkers comprising: Axonal Proteins: α IIspectrin (and SPDB)-1, NF-68 (NF-L)-2, Tau-3, α II, III spectrin, NF-200(NF-H), NF-160 (NF-M), Amyloid precursor protein, a internexin;Dendritic Proteins: beta III-tubulin-1, p24 microtubule-associatedprotein-2, alpha-Tubulin (P02551), beta-Tubulin (P04691), MAP-2A/B-3,MAP-2C-3, Stathmin-4, Dynamin-1 (P21575), Phocein, Dynactin (Q13561),Vimentin (P31000), Dynamin, Profilin, Cofilin 1,2; Somal Proteins:UCH-L1 (Q00981)-1, Glycogen phosphorylase-BB-2, PEBP (P31044), NSE(P07323), CK-BB (P07335), Thy 1.1, Prion protein, Huntingtin, 14-3-3proteins (e.g. 14-3-3-epsolon (P42655)), SM22-α, Calgranulin AB,alpha-Synuclein (P37377), beta-Synuclein (Q63754), HNP 22; Neuralnuclear proteins: NeuN-1, S/G(2) nuclear autoantigen (SG2NA),Huntingtin; Presynaptic Proteins: Synaptophysin-1, Synaptotagmin(P21707), Synaptojanin-1 (Q62910), Synaptojanin-2, Synapsin1(Synapsin-Ia), Synapsin2 (Q63537), Synapsin3, GAP43, Bassoon(NP_003449),Piccolo (aczonin) (NP_149015), Syntaxin, CRMP1, 2, Amphiphysin-1(NP_001626), Amphiphysin-2 (NP_647477); Post-Synaptic Proteins: PSD95-1,NMDA-receptor (and all subtypes)-2, PSD93, AMPA-kainate receptor (allsubtypes), mGluR (all subtypes), Calmodulin dependent protein kinase II(CAMPK)-alpha, beta, gamma, CaMPK-IV, SNAP-25, a-/b-SNAP;Myelin-Oligodendrocyte: Myelin basic protein (MBP) and fragments, Myelinproteolipid protein (PLP), Myelin Oligodendrocyte specific protein(MOSP), Myelin Oligodendrocyte glycoprotein (MOG), myelin associatedprotein (MAG), Oligodendrocyte NS-1 protein; Glial Protein Biomarkers:GFAP (P47819), Protein disulfide isomerase (PDI)-P04785, Neurocalcindelta, S100beta; Microglia protein Biomarkers: Iba1, OX-42, OX-8, OX-6,ED-1, PTPase (CD45), CD40, CD68, CD11b, Fractalkine (CX3CL1) andFractalkine receptor (CX3CR1), 5-d-4 antigen; Schwann cell markers:Schwann cell myelin protein; Glia Scar: Tenascin; Hippocampus: Stathmin,Hippocalcin, SCG10; Cerebellum: Purkinje cell protein-2 (Pcp2),Calbindin D9K, Calbindin D28K (NP_114190), Cerebellar CaBP, spot 35;Cerebrocortex: Cortexin-1 (P60606), H-2Z1 gene product; Thalamus: CD15(3-fucosyl-N-acetyl-lactosamine) epitope; Hypothalamus: Orexin receptors(OX-1R and OX-2R)-appetite, Orexins (hypothalamus-specific peptides);Corpus callosum: MBP, MOG, PLP, MAG; Spinal Cord: Schwann cell myelinprotein; Striatum: Striatin, Rhes (Ras homolog enriched in striatum);Peripheral ganglia: Gadd45a; Peripherial nerve fiber(sensory+motor):Peripherin, Peripheral myelin protein 22 (AAH91499); OtherNeuron-specific proteins: PH8 (S Serotonergic Dopaminergic, PEP-19,Neurocalcin (NC), a neuron-specific EF-hand Ca²⁺-binding protein,Encephalopsin, Striatin, SG2NA, Zinedin, Recoverin, Visinin;Neurotransmitter Receptors: NMDA receptor subunits (e.g. NR1A2B),Glutamate receptor subunits (AMPA, Kainate receptors (e.g. GluR1,GluR4), beta-adrenoceptor subtypes (e.g. beta(2)), Alpha-adrenoceptorssubtypes (e.g. alpha(2c)), GABA receptors (e.g. GABA(B)), Metabotropicglutamate receptor (e.g. mGluR3), 5-HT serotonin receptors (e.g.5-HT(3)), Dopamine receptors (e.g. D4), Muscarinic Ach receptors (e.g.M1), Nicotinic Acetylcholine Receptor (e.g. alpha-7); NeurotransmitterTransporters: Norepinephrine Transporter (NET), Dopamine transporter(DAT), Serotonin transporter (SERT), Vesicular transporter proteins(VMAT1 and VMAT2), GABA transporter vesicular inhibitory amino acidtransporter (VIAAT/VGAT), Glutamate Transporter (e.g. GLT1), Vesicularacetylcholine transporter, Vesicular Glutamate Transporter 1, [VGLUT1;BNPI] and VGLUT2, Choline transporter, (e.g. CHT1); CholinergicBiomarkers: Acetylcholine Esterase, Choline acetyltransferase [ChAT];Dopaminergic Biomarkers: Tyrosine Hydroxylase (TH), Phospho-TH, DARPP32;Noradrenergic Biomarkers: Dopamine beta-hydroxylase (DbH); AdrenergicBiomarkers: Phenylethanolamine N-methyltransferase (PNMT); SerotonergicBiomarkers: Tryptophan Hydroxylase (TrH); Glutamatergic Biomarkers:Glutaminase, Glutamine synthetase; GABAergic Biomarkers: GABAtransaminase [GABAT]), GABA-B-R2.

In another preferred embodiment, detection of neural damage comprisesdetection of one or more biomarkers comprising at least one biomarkerfrom each neural cell type. The composition of biomarkers is diagnosticof neural injury, damage and/or neural disorders. The composition orpanel of biomarkers comprises: α II spectrin, SPDB-1, NF-68, NF-L-2,Tau-3, βIII-tubulin-1, p24 microtubule-associated protein-2, UCH-L1(Q00981)-1, Glycogen phosphorylase-BB-2, NeuN-1, Synaptophysin-1,synaptotagmin (P21707), Synaptojanin-1 (Q62910), Synaptojanin-2,PSD95-1, NMDA-receptor-2 and subtypes, myelin basic protein (MBP) andfragments, GFAP (P47819), Iba1, OX-42, OX-8, OX-6, ED-1, Schwann cellmyelin protein, tenascin, stathmin, Purkinje cell protein-2 (Pcp2),Cortexin-1 (P60606), Orexin receptors (OX-1R, OX-2R), Striatin, Gadd45a,Peripherin, peripheral myelin protein 22 (AAH91499), and Neurocalcin(NC).

A biological sample can be obtained from a subject by conventionaltechniques. For example, CSF can be obtained by lumbar puncture. Bloodcan be obtained by venipuncture, while plasma and serum can be obtainedby fractionating whole blood according to known methods. Surgicaltechniques for obtaining solid tissue samples are well known in the art.For example, methods for obtaining a nervous system tissue sample aredescribed in standard neurosurgery texts such as Atlas of Neurosurgery:Basic Approaches to Cranial and Vascular Procedures, by F. Meyer,Churchill Livingstone, 1999; Stereotactic and Image Directed Surgery ofBrain Tumors, 1st ed., by David G. T. Thomas, WB Saunders Co., 1993; andCranial Microsurgery: Approaches and Techniques, by L. N. Sekhar and E.De Oliveira, 1st ed., Thieme Medical Publishing, 1999. Methods forobtaining and analyzing brain tissue are also described in Belay et al.,Arch. Neurol. 58: 1673-1678 (2001); and Seijo et al., J. Clin.Microbiol. 38: 3892-3895 (2000).

Any animal that expresses the neural proteins, such as for example,those listed in Table 1, can be used as a subject from which abiological sample is obtained. Preferably, the subject is a mammal, suchas for example, a human, dog, cat, horse, cow, pig, sheep, goat,primate, rat, mouse and other vertebrates such as fish, birds andreptiles. More preferably, the subject is a human. Particularlypreferred are subjects suspected of having or at risk for developingtraumatic or non-traumatic nervous system injuries, such as victims ofbrain injury caused by traumatic insults (e.g. gunshots wounds,automobile accidents, sports accidents, shaken baby syndrome), ischemicevents (e.g. stroke, cerebral hemorrhage, cardiac arrest), spinal cordinjury, neurodegenerative disorders (such as Alzheimer's, Huntington's,and Parkinson's diseases; Prion-related disease; other forms ofdementia, and spinal cord degeneration), epilepsy, substance abuse(e.g., from amphetamines, methamphetamine/Speed, Ecstasy/MDMA, orethanol and cocaine), and peripheral nervous system pathologies such asdiabetic neuropathy, chemotherapy-induced neuropathy and neuropathicpain, peripheral nerve damage or atrophy (ALS), multiple sclerosis (MS).

Subcellular neuronal markers Axonal Proteins α II spectrin (and SPDB) -1NF-68 (NF-L) - 2 Tau - 3 β II, III spectrin NF-200 (NF-H) NF-160 (NF-M)Amyloid precursor protein α internexin Dendritic ProteinsbetaIII-tubulin - 1 p24 microtubule-associated protein - 2 alpha-Tubulin(P02551) beta-Tubulin (P04691) MAP-2A/B - 3 MAP-2C -3 Stathmin - 4Dynamin-1 (P21575) Phocein Dynactin (Q13561) Vimentin (P31000) DynaminProfilin Cofilin 1,2 Somal Proteins UCH-L1 (Q00981) - 1 Gyocogenphosphorylase-BB - 2 PEBP (P31044) NSE (P07323) CK-BB (P07335) Thy 1.1Prion protein Huntingtin 14-3-3 proteins (e.g. 14-3-3-epsolon (P42655))SM22-α Calgranulin AB alpha-Synuclein (P37377) beta-Synuclein (Q63754)HNP 22 Neural nuclear proteins NeuN - 1 S/G(2) nuclear autoantigen(SG2NA) Huntingtin Presynaptic Proteins Synaptophysin - 1 Synaptotagmin(P21707) Synaptojanin-1 (Q62910) Synaptojanin-2 Synapsin1 (Synapsin-Ia)Synapsin2 (Q63537) Synapsin3 GAP43 Bassoon(NP_003449) Piccolo (aczonin)(NP_149015) Syntaxin CRMP1, 2 Amphiphysin -1 (NP_001626) Amphiphysin -2(NP_647477) Post-Synaptic Proteins PSD95 - 1 NMDA-receptor (and allsubtypes) -2 PSD93 AMPA-kainate receptor (all subtypes) mGluR (allsubtypes) Calmodulin dependent protein kinase II (CAMPK)-alpha, beta,gamma CaMPK-IV SNAP-25 a-/b-SNAP Nervous Cell subtype BiomarkersMyelin-Oligodendrocyte Myelin basic protein (MBP) and fragments Myelinproteolipid protein (PLP) Myelin Oligodendrocyte specific protein (MOSP)Myelin Oligodendrocyte glycoprotein (MOG) myelin associated protein(MAG) Oligodendrocyte NS-1 protein Glial Protein Biomarkers GFAP(P47819) Protein disulfide isomerase (PDI) - P04785 Neurocalcin deltaS100beta Microglia protein Biomarkers Iba1 OX-42 OX-8 OX-6 ED-1 PTPase(CD45) CD40; CD68 CD11b Fractalkine (CX3CL1) and Fractalkine receptor(CX3CR1) 5-d-4 antigen Schwann cell markers Schwann cell myelin proteinGlia Scar Tenascin Anatomical brain biomarkers (CNS + PNS) HippocampusStathmin, Hippocalcin SCG10 Cerebellum Purkinje cell protein-2 (Pcp2)Calbindin D9K, Calbindin D28K (NP_114190) Cerebellar CaBP, spot 35Cerebrocortex Cortexin-1. P60606 H-2Z1 gene product Thalamus CD15(3-fucosyl-N-acetyl-lactosamine) epitope Hypothalamus Orexin receptors(OX-1R and OX-2R)- appetite Orexins (hypothalamus-specific peptides)Corpus callosum MBP, MOG, PLP MAG Spinal Cord Schwann cell myelinprotein Striatum Striatin Rhes (Ras homolog enriched in striatum)Peripheral ganglia Gadd45a Peripherial nerve fiber(sensory + motor)Peripherin Peripheral myelin protein 22 (AAH91499) Other Neuron-specificproteins PH8 (S Serotonergic Dopaminergic PEP-19, a neuron-specificprotein Neurocalcin (NC), a neuron-specific EF-hand Ca2+-binding proteinEncephalopsin Striatin SG2NA Zinedin, Recoverin Visinin Neuron Subtypesbased on Neurotransmitter receptors and transporters NeurotransmitterReceptors NMDA receptor subunits (e.g. NR1A2B) Glutamate receptorsubunits (AMPA, Kainate receptors (e.g. GluR1, GluR4) beta-adrenoceptorsubtypes (e.g. beta(2)) Alpha-adrenoceptors subtypes (e.g. alpha(2c))GABA receptors (e.g. GABA(B)) Metabotropic glutamate receptor (e.g.mGluR3) 5-HT serotonin receptors (e.g. 5-HT(3)) Dopamine receptors (e.g.D4) Muscarinic Ach receptors (e.g. M1) Nicotinic Acetylcholine Receptor(e.g. alpha-7) Neurotransmitter Transporters Norepinephrine Transporter(NET) Dopamine transporter (DAT) Serotonin transporter (SERT) Vesiculartransporter proteins (VMAT1 and VMAT2) GABA transporter vesicularinhibitory amino acid transporter (VIAAT/VGAT) Glutamate Transporter(e.g. GLT1) Vesicular acetylcholine transporter Vesicular GlutamateTransporter 1 [VGLUT1; BNPI] and VGLUT2 Choline transporter, (e.g. CHT1)Neuron Subtypes based on Neurotransmitter system Cholinergic BiomarkersAcetylcholine Esterase Choline acetyltransferase [ChAT] DopaminergicBiomarkers Tyrosine Hydroxylase (TH) Phospho-TH DARPP32 NoradrenergicBiomarkers Dopamine beta-hydroxylase (DbH) Adrenergic BiomarkersPhenylethanolamine N-methyltransferase (PNMT) Serotonergic BiomarkersTryptophan Hydroxylase (TrH) Glutamatergic Biomarkers GlutaminaseGlutamine synthetase GABAergic Biomarkers GABA transaminase [GABAT])GABA-B-R2

As described above, the invention provides the step of correlating thepresence or amount of one or more neural protein(s) with the severityand/or type of nerve cell injury. The amount of a neural proteins,peptides, fragments, derivatives or the modified forms, thereof,directly relates to severity of nerve tissue injury as more severeinjury damages a greater number of nerve cells which in turn causes alarger amount of neural protein(s) to accumulate in the biologicalsample (e.g., CSF). Whether a nerve cell injury triggers an apoptotic,oncotic (necrotic) or type 2 (autophagic) cell death, can be determinedby examining the unique proteins released into the biofluid in responseto different cell death phenotype. The unique proteins are detected fromthe many cell types that comprise the nervous system. For example,astroglia, oligodendrocytes, microglia cells, Schwann cells, fibroblast,neuroblast, neural stem cells and mature neurons. Furthermore, matureneurons are differentiated into dedicated subtype fusing a primaryneural transmitter such as cholinergic (nicotinic and mucarinic),glutamatergic, gabaergic, serotonergic, dopaminergic. Each of thisneuronal subtype express unique neural proteins such as those dedicatedfor the synthesis, metabolism and transporter and receptor of eachunique neurotransmitter system (Table 1). Lastly, within a single nervecell, there are subcellularly defined structures matched with uniqueneural proteins (dendritic, axonal, myelin sheath, presynaptic terminaland postsynaptic density). By monitoring the release of proteins uniqueto each of these regions, subcellular damage can be monitored anddefined after brain injury (FIG. 2).

The biomarkers of the invention can be detected in a sample by anymeans. Methods for detecting the biomarkers are described in detail inthe materials and methods and Examples which follow. For example,immunoassays, include but are not limited to competitive andnon-competitive assay systems using techniques such as western blots,radioimmunoassays, ELISA (enzyme linked immunosorbent assay), “sandwich”immunoassays, immunoprecipitation assays, precipitin reactions, geldiffusion precipitin reactions, immunodiffusion assays, fluorescentimmunoassays and the like. Such assays are routine and well known in theart (see, e.g., Ausubel et al, eds, 1994, Current Protocols in MolecularBiology, Vol. 1, John Wiley & Sons, Inc., New York, which isincorporated by reference herein in its entirety). Exemplaryimmunoassays are described briefly below (but are not intended by way oflimitation).

Immunoprecipitation protocols generally comprise lysing a population ofcells in a lysis buffer such as RIPA buffer (1% NP-40 or Triton X-100,1% sodium deoxycholate, 0.1% SDS, 0.15 M NaCl, 0.01 M sodium phosphateat pH 7.2, 1% Trasylol) supplemented with protein phosphatase and/orprotease inhibitors (e.g., EDTA, PMSF, aprotinin, sodium vanadate),adding an antibody of interest to the cell lysate, incubating for aperiod of time (e.g., 1-4 hours) at 4° C., adding protein A and/orprotein G sepharose beads to the cell lysate, incubating for about anhour or more at 4° C., washing the beads in lysis buffer andresuspending the beads in SDS/sample buffer. The ability of the antibodyto immunoprecipitate a particular antigen can be assessed by, e.g.,western blot analysis. One of skill in the art would be knowledgeable asto the parameters that can be modified to increase the binding of theantibody to an antigen and decrease the background (e.g., pre-clearingthe cell lysate with sepharose beads). For further discussion regardingimmunoprecipitation protocols see, e.g., Ausubel et al, eds, 1994,Current Protocols in Molecular Biology, Vol. 1, John Wiley & Sons, Inc.,New York at 10.16.1.

Western blot analysis generally comprises preparing protein samples,electrophoresis of the protein samples in a polyacrylamide gel (e.g.,8%-20% SDS-PAGE depending on the molecular weight of the antigen),transferring the protein sample from the polyacrylamide gel to amembrane such as nitrocellulose, PVDF or nylon, blocking the membrane inblocking solution (e.g., PBS with 3% BSA or non-fat milk), washing themembrane in washing buffer (e.g., PBS-Tween 20), blocking the membranewith primary antibody (the antibody of interest) diluted in blockingbuffer, washing the membrane in washing buffer, blocking the membranewith a secondary antibody (which recognizes the primary antibody, e.g.,an anti-human antibody) conjugated to an enzymatic substrate (e.g.,horseradish peroxidase or alkaline phosphatase) or radioactive molecule(e.g., ³²P or ¹²⁵I) diluted in blocking buffer, washing the membrane inwash buffer, and detecting the presence of the antigen. One of skill inthe art would be knowledgeable as to the parameters that can be modifiedto increase the signal detected and to reduce the background noise. Forfurther discussion regarding western blot protocols see, e.g., Ausubelet al, eds, 1994, Current Protocols in Molecular Biology, Vol. 1, JohnWiley & Sons, Inc., New York at 10.8.1.

ELISAs comprise preparing antigen (i.e. neural biomarker), coating thewell of a 96 well microtiter plate with the antigen, adding the antibodyof interest conjugated to a detectable compound such as an enzymaticsubstrate (e.g., horseradish peroxidase or alkaline phosphatase) to thewell and incubating for a period of time, and detecting the presence ofthe antigen. In ELISAs the antibody of interest does not have to beconjugated to a detectable compound; instead, a second antibody (whichrecognizes the antibody of interest) conjugated to a detectable compoundmay be added to the well. Further, instead of coating the well with theantigen, the antibody may be coated to the well. In this case, a secondantibody conjugated to a detectable compound may be added following theaddition of the antigen of interest to the coated well. One of skill inthe art would be knowledgeable as to the parameters that can be modifiedto increase the signal detected as well as other variations of ELISAsknown in the art. For further discussion regarding ELISAs see, e.g.,Ausubel et al, eds, 1994, Current Protocols in Molecular Biology, Vol.1, John Wiley & Sons, Inc., New York at 11.2.1.

Identification of New Markers and Quantitation of Markers

In a preferred embodiment, a biological sample is obtained from apatient with neural injury. Biological samples comprising biomarkersfrom other patients and control subjects (i.e. normal healthyindividuals of similar age, sex, physical condition) are used ascomparisons. Biological samples are extracted as discussed above.Preferably, the sample is prepared prior to detection of biomarkers.Typically, preparation involves fractionation of the sample andcollection of fractions determined to contain the biomarkers. Methods ofpre-fractionation include, for example, size exclusion chromatography,ion exchange chromatography, heparin chromatography, affinitychromatography, sequential extraction, gel electrophoresis and liquidchromatography. The analytes also may be modified prior to detection.These methods are useful to simplify the sample for further analysis.For example, it can be useful to remove high abundance proteins, such asalbumin, from blood before analysis.

In one embodiment, a sample can be pre-fractionated according to size ofproteins in a sample using size exclusion chromatography. For abiological sample wherein the amount of sample available is small,preferably a size selection spin column is used. In general, the firstfraction that is eluted from the column (“fraction 1”) has the highestpercentage of high molecular weight proteins; fraction 2 has a lowerpercentage of high molecular weight proteins; fraction 3 has even alower percentage of high molecular weight proteins; fraction 4 has thelowest amount of large proteins; and so on. Each fraction can then beanalyzed by immunoassays, gas phase ion spectrometry, and the like, forthe detection of markers.

In another embodiment, a sample can be pre-fractionated by anionexchange chromatography. Anion exchange chromatography allowspre-fractionation of the proteins in a sample roughly according to theircharge characteristics. For example, a Q anion-exchange resin can beused (e.g., Q HyperD F, Biosepra), and a sample can be sequentiallyeluted with eluants having different pH's. Anion exchange chromatographyallows separation of biomarkers in a sample that are more negativelycharged from other types of biomarkers. Proteins that are eluted with aneluant having a high pH is likely to be weakly negatively charged, and afraction that is eluted with an eluant having a low pH is likely to bestrongly negatively charged. Thus, in addition to reducing complexity ofa sample, anion exchange chromatography separates proteins according totheir binding characteristics.

In yet another embodiment, a sample can be pre-fractionated by heparinchromatography. Heparin chromatography allows pre-fractionation of themarkers in a sample also on the basis of affinity interaction withheparin and charge characteristics. Heparin, a sulfatedmucopolysaccharide, will bind markers with positively charged moietiesand a sample can be sequentially eluted with eluants having differentpH's or salt concentrations. Markers eluted with an eluant having a lowpH are more likely to be weakly positively charged. Markers eluted withan eluant having a high pH are more likely to be strongly positivelycharged. Thus, heparin chromatography also reduces the complexity of asample and separates markers according to their binding characteristics.

In yet another embodiment, a sample can be pre-fractionated by isolatingproteins that have a specific characteristic, e.g. are glycosylated. Forexample, a CSF sample can be fractionated by passing the sample over alectin chromatography column (which has a high affinity for sugars).Glycosylated proteins will bind to the lectin column andnon-glycosylated proteins will pass through the flow through.Glycosylated proteins are then eluted from the lectin column with aneluant containing a sugar, e.g., N-acetyl-glucosamine and are availablefor further analysis.

Thus there are many ways to reduce the complexity of a sample based onthe binding properties of the proteins in the sample, or thecharacteristics of the proteins in the sample.

In yet another embodiment, a sample can be fractionated using asequential extraction protocol. In sequential extraction, a sample isexposed to a series of adsorbents to extract different types ofbiomarkers from a sample. For example, a sample is applied to a firstadsorbent to extract certain proteins, and an eluant containingnon-adsorbent proteins (i.e., proteins that did not bind to the firstadsorbent) is collected. Then, the fraction is exposed to a secondadsorbent. This further extracts various proteins from the fraction.This second fraction is then exposed to a third adsorbent, and so on.

Any suitable materials and methods can be used to perform sequentialextraction of a sample. For example, a series of spin columns comprisingdifferent adsorbents can be used. In another example, a multi-wellcomprising different adsorbents at its bottom can be used. In anotherexample, sequential extraction can be performed on a probe adapted foruse in a gas phase ion spectrometer, wherein the probe surface comprisesadsorbents for binding biomarkers. In this embodiment, the sample isapplied to a first adsorbent on the probe, which is subsequently washedwith an eluant. Markers that do not bind to the first adsorbent areremoved with an eluant. The markers that are in the fraction can beapplied to a second adsorbent on the probe, and so forth. The advantageof performing sequential extraction on a gas phase ion spectrometerprobe is that markers that bind to various adsorbents at every stage ofthe sequential extraction protocol can be analyzed directly using a gasphase ion spectrometer.

In yet another embodiment, biomarkers in a sample can be separated byhigh-resolution electrophoresis, e.g., one or two-dimensional gelelectrophoresis. A fraction containing a marker can be isolated andfurther analyzed by gas phase ion spectrometry. Preferably,two-dimensional gel electrophoresis is used to generate two-dimensionalarray of spots of biomarkers, including one or more markers. See, e.g.,Jungblut and Thiede, Mass Spectr. Rev. 16:145-162 (1997). Thetwo-dimensional gel electrophoresis can be performed using methods knownin the art. See, e.g., Deutscher ed., Methods In Enzymology vol. 182.Typically, biomarkers in a sample are separated by, e.g., isoelectricfocusing, during which biomarkers in a sample are separated in a pHgradient until they reach a spot where their net charge is zero (i.e.,isoelectric point). This first separation step results inone-dimensional array of biomarkers. The biomarkers in one dimensionalarray is further separated using a technique generally distinct fromthat used in the first separation step. For example, in the seconddimension, biomarkers separated by isoelectric focusing are furtherseparated using a polyacrylamide gel, such as polyacrylamide gelelectrophoresis in the presence of sodium dodecyl sulfate (SDS-PAGE).SDS-PAGE gel allows further separation based on molecular mass ofbiomarkers. Typically, two-dimensional gel electrophoresis can separatechemically different biomarkers in the molecular mass range from1000-200,000 Da within complex mixtures.

Biomarkers in the two-dimensional array can be detected using anysuitable methods known in the art. For example, biomarkers in a gel canbe labeled or stained (e.g., Coomassie Blue or silver staining). If gelelectrophoresis generates spots that correspond to the molecular weightof one or more markers of the invention, the spot can be furtheranalyzed by densitometric analysis or gas phase ion spectrometry. Forexample, spots can be excised from the gel and analyzed by gas phase ionspectrometry. Alternatively, the gel containing biomarkers can betransferred to an inert membrane by applying an electric field. Then aspot on the membrane that approximately corresponds to the molecularweight of a marker can be analyzed by gas phase ion spectrometry. In gasphase ion spectrometry, the spots can be analyzed using any suitabletechniques, such as MALDI or SELDI.

Prior to gas phase ion spectrometry analysis, it may be desirable tocleave biomarkers in the spot into smaller fragments using cleavingreagents, such as proteases (e.g., trypsin). The digestion of biomarkersinto small fragments provides a mass fingerprint of the biomarkers inthe spot, which can be used to determine the identity of markers ifdesired.

In yet another embodiment, high performance liquid chromatography (HPLC)can be used to separate a mixture of biomarkers in a sample based ontheir different physical properties, such as polarity, charge and size.HPLC instruments typically consist of a reservoir of mobile phase, apump, an injector, a separation column, and a detector. Biomarkers in asample are separated by injecting an aliquot of the sample onto thecolumn. Different biomarkers in the mixture pass through the column atdifferent rates due to differences in their partitioning behaviorbetween the mobile liquid phase and the stationary phase. A fractionthat corresponds to the molecular weight and/or physical properties ofone or more markers can be collected. The fraction can then be analyzedby gas phase ion spectrometry to detect markers.

Optionally, a marker can be modified before analysis to improve itsresolution or to determine its identity. For example, the markers may besubject to proteolytic digestion before analysis. Any protease can beused. Proteases, such as trypsin, that are likely to cleave the markersinto a discrete number of fragments are particularly useful. Thefragments that result from digestion function as a fingerprint for themarkers, thereby enabling their detection indirectly. This isparticularly useful where there are markers with similar molecularmasses that might be confused for the marker in question. Also,proteolytic fragmentation is useful for high molecular weight markersbecause smaller markers are more easily resolved by mass spectrometry.In another example, biomarkers can be modified to improve detectionresolution. For instance, neuraminidase can be used to remove terminalsialic acid residues from glycoproteins to improve binding to an anionicadsorbent and to improve detection resolution. In another example, themarkers can be modified by the attachment of a tag of particularmolecular weight that specifically bind to molecular markers, furtherdistinguishing them. Optionally, after detecting such modified markers,the identity of the markers can be further determined by matching thephysical and chemical characteristics of the modified markers in aprotein database (e.g., SwissProt).

After preparation, biomarkers in a sample are typically captured on asubstrate for detection. Traditional substrates include antibody-coated96-well plates or nitrocellulose membranes that are subsequently probedfor the presence of proteins. Preferably, the biomarkers are identifiedusing immunoassays as described above. However, preferred methods alsoinclude the use of biochips. Preferably the biochips are proteinbiochips for capture and detection of proteins. Many protein biochipsare described in the art. These include, for example, protein biochipsproduced by Packard BioScience Company (Meriden Conn.), Zyomyx (Hayward,Calif.) and Phylos (Lexington, Mass.). In general, protein biochipscomprise a substrate having a surface. A capture reagent or adsorbent isattached to the surface of the substrate. Frequently, the surfacecomprises a plurality of addressable locations, each of which locationhas the capture reagent bound there. The capture reagent can be abiological molecule, such as a polypeptide or a nucleic acid, whichcaptures other biomarkers in a specific manner. Alternatively, thecapture reagent can be a chromatographic material, such as an anionexchange material or a hydrophilic material. Examples of such proteinbiochips are described in the following patents or patent applications:U.S. Pat. No. 6,225,047 (Hutchens and Yip, “Use of retentatechromatography to generate difference maps,” May 1, 2001), Internationalpublication WO 99/51773 (Kuimelis and Wagner, “Addressable proteinarrays,” Oct. 14, 1999), International publication WO 00/04389 (Wagneret al., “Arrays of protein-capture agents and methods of use thereof,”Jul. 27, 2000), International publication WO 00/56934 (Englert et al.,“Continuous porous matrix arrays,” Sep. 28, 2000).

In general, a sample containing the biomarkers is placed on the activesurface of a biochip for a sufficient time to allow binding. Then,unbound molecules are washed from the surface using a suitable eluant.In general, the more stringent the eluant, the more tightly the proteinsmust be bound to be retained after the wash. The retained proteinbiomarkers now can be detected by appropriate means.

Analytes captured on the surface of a protein biochip can be detected byany method known in the art. This includes, for example, massspectrometry, fluorescence, surface plasmon resonance, ellipsometry andatomic force microscopy. Mass spectrometry, and particularly SELDI massspectrometry, is a particularly useful method for detection of thebiomarkers of this invention.

Preferably, a laser desorption time-of-flight mass spectrometer is usedin embodiments of the invention. In laser desorption mass spectrometry,a substrate or a probe comprising markers is introduced into an inletsystem. The markers are desorbed and ionized into the gas phase by laserfrom the ionization source. The ions generated are collected by an ionoptic assembly, and then in a time-of-flight mass analyzer, ions areaccelerated through a short high voltage field and let drift into a highvacuum chamber. At the far end of the high vacuum chamber, theaccelerated ions strike a sensitive detector surface at a differenttime. Since the time-of-flight is a function of the mass of the ions,the elapsed time between ion formation and ion detector impact can beused to identify the presence or absence of markers of specific mass tocharge ratio.

Matrix-assisted laser desorption/ionization mass spectrometry, orMALDI-MS, is a method of mass spectrometry that involves the use of anenergy absorbing molecule, frequently called a matrix, for desorbingproteins intact from a probe surface. MALDI is described, for example,in U.S. Pat. No. 5,118,937 (Hillenkamp et al.) and U.S. Pat. No.5,045,694 (Beavis and Chait). In MALDI-MS the sample is typically mixedwith a matrix material and placed on the surface of an inert probe.Exemplary energy absorbing molecules include cinnamic acid derivatives,sinapinic acid (“SPA”), cyano hydroxy cinnamic acid (“CHCA”) anddihydroxybenzoic acid. Other suitable energy absorbing molecules areknown to those skilled in this art. The matrix dries, forming crystalsthat encapsulate the analyte molecules. Then the analyte molecules aredetected by laser desorption/ionization mass spectrometry. MALDI-MS isuseful for detecting the biomarkers of this invention if the complexityof a sample has been substantially reduced using the preparation methodsdescribed above.

Surface-enhanced laser desorption/ionization mass spectrometry, orSELDI-MS represents an improvement over MALDI for the fractionation anddetection of biomolecules, such as proteins, in complex mixtures. SELDIis a method of mass spectrometry in which biomolecules, such asproteins, are captured on the surface of a protein biochip using capturereagents that are bound there. Typically, non-bound molecules are washedfrom the probe surface before interrogation. SELDI is described, forexample, in: U.S. Pat. No. 5,719,060 (“Method and Apparatus forDesorption and Ionization of Analytes,” Hutchens and Yip, Feb. 17,1998,) U.S. Pat. No. 6,225,047 (“Use of Retentate Chromatography toGenerate Difference Maps,” Hutchens and Yip, May 1, 2001) and Weinbergeret al., “Time-of-flight mass spectrometry,” in Encyclopedia ofAnalytical Chemistry, R. A. Meyers, ed., pp 11915-11918 John Wiley &Sons Chichesher, 2000.

Markers on the substrate surface can be desorbed and ionized using gasphase ion spectrometry. Any suitable gas phase ion spectrometers can beused as long as it allows markers on the substrate to be resolved.Preferably, gas phase ion spectrometers allow quantitation of markers.

In one embodiment, a gas phase ion spectrometer is a mass spectrometer.In a typical mass spectrometer, a substrate or a probe comprisingmarkers on its surface is introduced into an inlet system of the massspectrometer. The markers are then desorbed by a desorption source suchas a laser, fast atom bombardment, high energy plasma, electrosprayionization, thermospray ionization, liquid secondary ion MS, fielddesorption, etc. The generated desorbed, volatilized species consist ofpreformed ions or neutrals which are ionized as a direct consequence ofthe desorption event. Generated ions are collected by an ion opticassembly, and then a mass analyzer disperses and analyzes the passingions. The ions exiting the mass analyzer are detected by a detector. Thedetector then translates information of the detected ions intomass-to-charge ratios. Detection of the presence of markers or othersubstances will typically involve detection of signal intensity. This,in turn, can reflect the quantity and character of markers bound to thesubstrate. Any of the components of a mass spectrometer (e.g., adesorption source, a mass analyzer, a detector, etc.) can be combinedwith other suitable components described herein or others known in theart in embodiments of the invention.

In another embodiment, an immunoassay can be used to detect and analyzemarkers in a sample. This method comprises: (a) providing an antibodythat specifically binds to a marker; (b) contacting a sample with theantibody; and (c) detecting the presence of a complex of the antibodybound to the marker in the sample.

To prepare an antibody that specifically binds to a marker, purifiedmarkers or their nucleic acid sequences can be used. Nucleic acid andamino acid sequences for markers can be obtained by furthercharacterization of these markers. For example, each marker can bepeptide mapped with a number of enzymes (e.g., trypsin, V8 protease,etc.). The molecular weights of digestion fragments from each marker canbe used to search the databases, such as SwissProt database, forsequences that will match the molecular weights of digestion fragmentsgenerated by various enzymes. Using this method, the nucleic acid andamino acid sequences of other markers can be identified if these markersare known proteins in the databases.

Alternatively, the proteins can be sequenced using protein laddersequencing. Protein ladders can be generated by, for example,fragmenting the molecules and subjecting fragments to enzymaticdigestion or other methods that sequentially remove a single amino acidfrom the end of the fragment. Methods of preparing protein ladders aredescribed, for example, in International Publication WO 93/24834 (Chaitet al.) and U.S. Pat. No. 5,792,664 (Chait et al.). The ladder is thenanalyzed by mass spectrometry. The difference in the masses of theladder fragments identify the amino acid removed from the end of themolecule.

If the markers are not known proteins in the databases, nucleic acid andamino acid sequences can be determined with knowledge of even a portionof the amino acid sequence of the marker. For example, degenerate probescan be made based on the N-terminal amino acid sequence of the marker.These probes can then be used to screen a genomic or cDNA librarycreated from a sample from which a marker was initially detected. Thepositive clones can be identified, amplified, and their recombinant DNAsequences can be subcloned using techniques which are well known. See,e.g., Current Protocols for Molecular Biology (Ausubel et al., GreenPublishing Assoc. and Wiley-Interscience 1989) and Molecular Cloning: ALaboratory Manual, 3rd Ed. (Sambrook et al., Cold Spring HarborLaboratory, N Y 2001).

Using the purified markers or their nucleic acid sequences, antibodiesthat specifically bind to a marker can be prepared using any suitablemethods known in the art. See, e.g., Coligan, Current Protocols inImmunology (1991); Harlow & Lane, Antibodies: A Laboratory Manual(1988); Goding, Monoclonal Antibodies: Principles and Practice (2d ed.1986); and Kohler & Milstein, Nature 256:495-497 (1975). Such techniquesinclude, but are not limited to, antibody preparation by selection ofantibodies from libraries of recombinant antibodies in phage or similarvectors, as well as preparation of polyclonal and monoclonal antibodiesby immunizing rabbits or mice (see, e.g., Huse et al., Science246:1275-1281 (1989); Ward et al., Nature 341:544-546 (1989)).

After the antibody is provided, a marker can be detected and/orquantified using any of suitable immunological binding assays known inthe art (see, e.g., U.S. Pat. Nos. 4,366,241; 4,376,110; 4,517,288; and4,837,168). Useful assays include, for example, an enzyme immune assay(EIA) such as enzyme-linked immunosorbent assay (ELISA), a radioimmuneassay (MA), a Western blot assay, or a slot blot assay. These methodsare also described in, e.g., Methods in Cell Biology: Antibodies in CellBiology, volume 37 (Asai, ed. 1993); Basic and Clinical Immunology(Stites & Terr, eds., 7th ed. 1991); and Harlow & Lane, supra. Thedetection and quantitation of biomarkers is described in detail in theExamples which follow.

Generally, a sample obtained from a subject can be contacted with theantibody that specifically binds the marker. Optionally, the antibodycan be fixed to a solid support to facilitate washing and subsequentisolation of the complex, prior to contacting the antibody with asample. Examples of solid supports include glass or plastic in the formof, e.g., a microtiter plate, a stick, a bead, or a microbead.Antibodies can also be attached to a probe substrate or ProteinChip®array described above. The sample is preferably a biological fluidsample taken from a subject. Examples of biological fluid samplesinclude cerebrospinal fluid, blood, serum, plasma, neuronal cells,tissues, urine, tears, saliva etc. In a preferred embodiment, thebiological fluid comprises cerebrospinal fluid. The sample can bediluted with a suitable eluant before contacting the sample to theantibody.

After incubating the sample with antibodies, the mixture is washed andthe antibody-marker complex formed can be detected. This can beaccomplished by incubating the washed mixture with a detection reagent.This detection reagent may be, e.g., a second antibody which is labeledwith a detectable label. Exemplary detectable labels include magneticbeads (e.g., DYNABEADS™), fluorescent dyes, radiolabels, enzymes (e.g.,horse radish peroxide, alkaline phosphatase and others commonly used inan ELISA), and colorimetric labels such as colloidal gold or coloredglass or plastic beads. Alternatively, the marker in the sample can bedetected using an indirect assay, wherein, for example, a second,labeled antibody is used to detect bound marker-specific antibody,and/or in a competition or inhibition assay wherein, for example, amonoclonal antibody which binds to a distinct epitope of the marker isincubated simultaneously with the mixture.

Throughout the assays, incubation and/or washing steps may be requiredafter each combination of reagents. Incubation steps can vary from about5 seconds to several hours, preferably from about 5 minutes to about 24hours. However, the incubation time will depend upon the assay format,marker, volume of solution, concentrations and the like. Usually theassays will be carried out at ambient temperature, although they can beconducted over a range of temperatures, such as 10° C. to 40° C.

Immunoassays can be used to determine presence or absence of a marker ina sample as well as the quantity of a marker in a sample. First, a testamount of a marker in a sample can be detected using the immunoassaymethods described above. If a marker is present in the sample, it willform an antibody-marker complex with an antibody that specifically bindsthe marker under suitable incubation conditions described above. Theamount of an antibody-marker complex can be determined by comparing to astandard. A standard can be, e.g., a known compound or another proteinknown to be present in a sample. As noted above, the test amount ofmarker need not be measured in absolute units, as long as the unit ofmeasurement can be compared to a control.

The methods for detecting these markers in a sample have manyapplications. For example, one or more markers can be measured to aid inthe diagnosis of spinal injury, brain injury, the degree of injury,neural injury due to neuronal disorders, alcohol and drug abuse, fetalinjury due to alcohol and/or drug abuse by pregnant mothers, etc. Inanother example, the methods for detection of the markers can be used tomonitor responses in a subject to treatment. In another example, themethods for detecting markers can be used to assay for and to identifycompounds that modulate expression of these markers in vivo or in vitro.

Data generated by desorption and detection of markers can be analyzedusing any suitable means. In one embodiment, data is analyzed with theuse of a programmable digital computer. The computer program generallycontains a readable medium that stores codes. Certain code can bedevoted to memory that includes the location of each feature on a probe,the identity of the adsorbent at that feature and the elution conditionsused to wash the adsorbent. The computer also contains code thatreceives as input, data on the strength of the signal at variousmolecular masses received from a particular addressable location on theprobe. This data can indicate the number of markers detected, includingthe strength of the signal generated by each marker.

Data analysis can include the steps of determining signal strength(e.g., height of peaks) of a marker detected and removing “outliers”(data deviating from a predetermined statistical distribution). Theobserved peaks can be normalized, a process whereby the height of eachpeak relative to some reference is calculated. For example, a referencecan be background noise generated by instrument and chemicals (e.g.,energy absorbing molecule) which is set as zero in the scale. Then thesignal strength detected for each marker or other biomolecules can bedisplayed in the form of relative intensities in the scale desired(e.g., 100). Alternatively, a standard (e.g., a CSF protein) may beadmitted with the sample so that a peak from the standard can be used asa reference to calculate relative intensities of the signals observedfor each marker or other markers detected.

The computer can transform the resulting data into various formats fordisplaying. In one format, referred to as “spectrum view or retentatemap,” a standard spectral view can be displayed, wherein the viewdepicts the quantity of marker reaching the detector at each particularmolecular weight. In another format, referred to as “peak map,” only thepeak height and mass information are retained from the spectrum view,yielding a cleaner image and enabling markers with nearly identicalmolecular weights to be more easily seen. In yet another format,referred to as “gel view,” each mass from the peak view can be convertedinto a grayscale image based on the height of each peak, resulting in anappearance similar to bands on electrophoretic gels. In yet anotherformat, referred to as “3-D overlays,” several spectra can be overlaidto study subtle changes in relative peak heights. In yet another format,referred to as “difference map view,” two or more spectra can becompared, conveniently highlighting unique markers and markers which areup- or down-regulated between samples. Marker profiles (spectra) fromany two samples may be compared visually. In yet another format,Spotfire Scatter Plot can be used, wherein markers that are detected areplotted as a dot in a plot, wherein one axis of the plot represents theapparent molecular mass of the markers detected and another axisrepresents the signal intensity of markers detected. For each sample,markers that are detected and the amount of markers present in thesample can be saved in a computer readable medium. This data can then becompared to a control (e.g., a profile or quantity of markers detectedin control, e.g., normal, healthy subjects in whom neural injury isundetectable).

Diagnosis of Neural Injury

In another aspect, the invention provides methods for aiding a humanneural injury and/or neural disorder diagnosis using one or moremarkers. For example, proteins identified in Table 1, peptides,fragments or derivatives thereof. These markers can be used singularlyor in combination with other markers in any set, for example, axonal anddendritic. The markers are differentially present in samples of a humanpatient, for example a TBI patient, and a normal subject in whom neuralinjury is undetectable. For example, some of the markers are expressedat an elevated level and/or are present at a higher frequency in humanpatients with neural injury and/or neuronal disorders than in normalsubjects. Therefore, detection of one or more of these markers in aperson would provide useful information regarding the probability thatthe person may have neural injury and/or neuronal disorder.

Nervous system diseases, neuronal disorders, and/or conditions, whichcan be treated, prevented, and/or diagnosed with the compositions of theinvention (e.g., polypeptides, polynucleotides, and/or agonists orantagonists), include, but are not limited to, nervous system injuries,and diseases, disorders, and/or conditions which result in either adisconnection of axons, a diminution or degeneration of neurons, ordemyelination. Nervous system lesions which may be treated, prevented,and/or diagnosed in a patient (including human and non-human mammalianpatients) according to the invention, include but are not limited to,the following lesions of either the central (including spinal cord,brain) or peripheral nervous systems: (1) ischemic lesions, in which alack of oxygen in a portion of the nervous system results in neuronalinjury or death, including cerebral infarction or ischemia, or spinalcord infarction or ischemia; (2) traumatic lesions, including lesionscaused by physical injury or associated with surgery, for example,lesions which sever a portion of the nervous system, or compressioninjuries; (3) malignant lesions, in which a portion of the nervoussystem is destroyed or injured by malignant tissue which is either anervous system associated malignancy or a malignancy derived fromnon-nervous system tissue; (4) infectious lesions, in which a portion ofthe nervous system is destroyed or injured as a result of infection, forexample, by an abscess or associated with infection by humanimmunodeficiency virus, herpes zoster, or herpes simplex virus or withLyme disease, tuberculosis, syphilis; (5) degenerative lesions, in whicha portion of the nervous system is destroyed or injured as a result of adegenerative process including but not limited to degenerationassociated with Parkinson's disease, Alzheimer's disease, Huntington'schorea, or amyotrophic lateral sclerosis (ALS); (6) lesions associatedwith nutritional diseases, disorders, and/or conditions, in which aportion of the nervous system is destroyed or injured by a nutritionaldisorder or disorder of metabolism including but not limited to, vitaminB12 deficiency, folic acid deficiency, Wernicke disease, tobacco-alcoholamblyopia, Marchiafava-Bignami disease (primary degeneration of thecorpus callosum), and alcoholic cerebellar degeneration; (7)neurological lesions associated with systemic diseases including, butnot limited to, diabetes (diabetic neuropathy, Bell's palsy), systemiclupus erythematosus, carcinoma, or sarcoidosis; (8) lesions caused bytoxic substances including alcohol, lead, or particular neurotoxins; and(9) demyelinated lesions in which a portion of the nervous system isdestroyed or injured by a demyelinating disease including, but notlimited to, multiple sclerosis, human immunodeficiency virus-associatedmyelopathy, transverse myelopathy or various etiologies, progressivemultifocal leukoencephalopathy, and central pontine myelinolysis.

Accordingly, embodiments of the invention include methods for aidinghuman neural injury and/or neuronal disorders, wherein the methodcomprises: (a) detecting at least one marker in a sample, wherein themarker is selected from any one of the markers listed in Table 1,peptides, fragments and derivatives thereof; and (b) correlating thedetection of the marker or markers with a probable diagnosis of humanneural injury and/or neuronal disorder. The correlation may take intoaccount the amount of the marker or markers in the sample compared to acontrol amount of the marker or markers (up or down regulation of themarker or markers) (e.g., in normal subjects in whom human neural injuryis undetectable). The correlation may take into account the presence orabsence of the markers in a test sample and the frequency of detectionof the same markers in a control. The correlation may take into accountboth of such factors to facilitate determination of whether a subjecthas neural injury, the degree of severity of the neural injury, andsubcellular location of the injury, or not.

In a preferred embodiment, the method of diagnosing and detecting neuralinjury and/or neural disorders comprises detecting one or morebiomarkers: Axonal Proteins: α II spectrin (and SPDB)-1, NF-68 (NF-L)-2,Tau-3, α II, III spectrin, NF-200 (NF-H), NF-160 (NF-M), Amyloidprecursor protein, α internexin; Dendritic Proteins: beta III-tubulin-1,p24 microtubule-associated protein-2, alpha-Tubulin (P02551),beta-Tubulin (P04691), MAP-2A/B-3, MAP-2C-3, Stathmin-4, Dynamin-1(P21575), Phocein, Dynactin (Q13561), Vimentin (P31000), Dynamin,Profilin, Cofilin 1,2; Somal Proteins: UCH-L1 (Q00981)-1, Glycogenphosphorylase-BB-2, PEBP (P31044), NSE (P07323), CK-BB (P07335), Thy1.1, Prion protein, Huntingtin, 14-3-3 proteins (e.g. 14-3-3-epsolon(P42655)), SM22-α, Calgranulin AB, alpha-Synuclein (P37377),beta-Synuclein (Q63754), HNP 22; Neural nuclear proteins: NeuN-1, S/G(2)nuclear autoantigen (SG2NA), Huntingtin; Presynaptic Proteins:Synaptophysin-1, Synaptotagmin (P21707), Synaptojanin-1 (Q62910),Synaptojanin-2, Synapsin 1 (Synapsin-Ia), Synapsin2 (Q63537), Synapsin3,GAP43, Bassoon(NP_003449), Piccolo (aczonin) (NP_149015), Syntaxin,CRMP1, 2, Amphiphysin-1 (NP_001626), Amphiphysin-2 (NP_647477);Post-Synaptic Proteins: PSD95-1, NMDA-receptor (and all subtypes)-2,PSD93, AMPA-kainate receptor (all subtypes), mGluR (all subtypes),Calmodulin dependent protein kinase II (CAMPK)-alpha, beta, gamma,CaMPK-IV, SNAP-25, a-/b-SNAP; Myelin-Oligodendrocyte: Myelin basicprotein (MBP) and fragments, Myelin proteolipid protein (PLP), MyelinOligodendrocyte specific protein (MOSP), Myelin Oligodendrocyteglycoprotein (MOG), myelin associated protein (MAG), OligodendrocyteNS-1 protein; Glial Protein Biomarkers: GFAP (P47819), Protein disulfideisomerase (PDI)-P04785, Neurocalcin delta, S100beta; Microglia proteinBiomarkers: Iba1, OX-42, OX-8, OX-6, ED-1, PTPase (CD45), CD40, CD68,CD11b, Fractalkine (CX3CL1) and Fractalkine receptor (CX3CR1), 5-d-4antigen; Schwann cell markers: Schwann cell myelin protein; Glia Scar:Tenascin; Hippocampus: Stathmin, Hippocalcin, SCG10; Cerebellum:Purkinje cell protein-2 (Pcp2), Calbindin D9K, Calbindin D28K(NP_114190), Cerebellar CaBP, spot 35; Cerebrocortex: Cortexin-1(P60606), H-2Z1 gene product; Thalamus: CD15(3-fucosyl-N-acetyl-lactosamine) epitope; Hypothalamus: Orexin receptors(OX-1R and OX-2R)-appetite, Orexins (hypothalamus-specific peptides);Corpus callosum: MBP, MOG, PLP, MAG; Spinal Cord: Schwann cell myelinprotein; Striatum: Striatin, Rhes (Ras homolog enriched in striatum);Peripheral ganglia: Gadd45a; Peripherial nerve fiber(sensory+motor):Peripherin, Peripheral myelin protein 22 (AAH91499); OtherNeuron-specific proteins: PH8 (S Serotonergic Dopaminergic, PEP-19,Neurocalcin (NC), a neuron-specific EF-hand Ca²⁺-binding protein,Encephalopsin, Striatin, SG2NA, Zinedin, Recoverin, Visinin;Neurotransmitter Receptors: NMDA receptor subunits (e.g. NR1A2B),Glutamate receptor subunits (AMPA, Kainate receptors (e.g. GluR1,GluR4), beta-adrenoceptor subtypes (e.g. beta(2)), Alpha-adrenoceptorssubtypes (e.g. alpha(2c)), GABA receptors (e.g. GABA(B)), Metabotropicglutamate receptor (e.g. mGluR3), 5-HT serotonin receptors (e.g.5-HT(3)), Dopamine receptors (e.g. D4), Muscarinic Ach receptors (e.g.M1), Nicotinic Acetylcholine Receptor (e.g. alpha-7); NeurotransmitterTransporters: Norepinephrine Transporter (NET), Dopamine transporter(DAT), Serotonin transporter (SERT), Vesicular transporter proteins(VMAT1 and VMAT2), GABA transporter vesicular inhibitory amino acidtransporter (VIAAT/VGAT), Glutamate Transporter (e.g. GLT1), Vesicularacetylcholine transporter, Vesicular Glutamate Transporter 1, [VGLUT1;BNPI] and VGLUT2, Choline transporter, (e.g. CHT1); CholinergicBiomarkers: Acetylcholine Esterase, Choline acetyltransferase [ChAT];Dopaminergic Biomarkers: Tyrosine Hydroxylase (TH), Phospho-TH, DARPP32;Noradrenergic Biomarkers: Dopamine beta-hydroxylase (DbH); AdrenergicBiomarkers: Phenylethanolamine N-methyltransferase (PNMT); SerotonergicBiomarkers: Tryptophan Hydroxylase (TrH); Glutamatergic Biomarkers:Glutaminase, Glutamine synthetase; GABAergic Biomarkers: GABAtransaminase [GABAT]), GABA-B-R2.

In another preferred embodiment, the method of diagnosing and detectingneural injury and/or neural disorders comprises detecting at least onebiomarker from each neural cell type. The composition of biomarkers isdiagnostic of neural injury, damage and/or neural disorders. Thecomposition comprises: α II spectrin, SPDB-1, NF-68, NF-L-2, Tau-3,βIII-tubulin-1, p24 microtubule-associated protein-2, UCH-L1 (Q00981)-1,Glycogen phosphorylase-BB-2, NeuN-1, Synaptophysin-1, synaptotagmin(P21707), Synaptojanin-1 (Q62910), Synaptojanin-2, PSD95-1,NMDA-receptor-2 and subtypes, myelin basic protein (MBP) and fragments,GFAP (P47819), Iba1, OX-42, OX-8, OX-6, ED-1, Schwann cell myelinprotein, tenascin, stathmin, Purkinje cell protein-2 (Pcp2), Cortexin-1(P60606), Orexin receptors (OX-1R, OX-2R), Striatin, Gadd45a,Peripherin, peripheral myelin protein 22 (AAH91499), and Neurocalcin(NC).

Any suitable samples can be obtained from a subject to detect markers.Preferably, a sample is a cerebrospinal fluid sample from the subject.If desired, the sample can be prepared as described above to enhancedetectability of the markers. For example, to increase the detectabilityof markers, a blood serum sample from the subject can be preferablyfractionated by, e.g., Cibacron blue agarose chromatography and singlestranded DNA affinity chromatography, anion exchange chromatography andthe like. Sample preparations, such as pre-fractionation protocols, isoptional and may not be necessary to enhance detectability of markersdepending on the methods of detection used. For example, samplepreparation may be unnecessary if antibodies that specifically bindmarkers are used to detect the presence of markers in a sample.

Any suitable method can be used to detect a marker or markers in asample. For example, an immunoassay or gas phase ion spectrometry can beused as described above. Using these methods, one or more markers can bedetected. Preferably, a sample is tested for the presence of a pluralityof markers. Detecting the presence of a plurality of markers, ratherthan a single marker alone, would provide more information for thediagnostician. Specifically, the detection of a plurality of markers ina sample would increase the percentage of true positive and truenegative diagnoses and would decrease the percentage of false positiveor false negative diagnoses.

The detection of the marker or markers is then correlated with aprobable diagnosis of neural injury and/or neuronal disorders. In someembodiments, the detection of the mere presence or absence of a marker,without quantifying the amount of marker, is useful and can becorrelated with a probable diagnosis of neural injury and/or neuronaldisorders. For example, neural proteins, fragments or derivativesthereof, such as for example, axonal proteins—NF-200 (NF-H), NF-160(NF-M), NF-68 (NF-L); can be more frequently detected in patients withneuronal injury than in normal subjects.

In other embodiments, the detection of markers can involve quantifyingthe markers to correlate the detection of markers with a probablediagnosis of neural injury, degree of severity of neural injury,diagnosis of neural disorders and the like. Thus, if the amount of themarkers detected in a subject being tested is higher compared to acontrol amount, then the subject being tested has a higher probabilityof having such injuries and/or neural disorders.

Similarly, in another embodiment, the detection of markers can furtherinvolve quantifying the markers to correlate the detection of markerswith a probable diagnosis of neural injury, degree of severity of neuralinjury, diagnosis of neural disorders and the like, wherein the markersare present in lower quantities in CSF or blood serum samples frompatients than in blood serum samples of normal subjects. Thus, if theamount of the markers detected in a subject being tested is lowercompared to a control amount, then the subject being tested has a higherprobability of having neural injury and/or neural disorder.

When the markers are quantified, it can be compared to a control. Acontrol can be, e.g., the average or median amount of marker present incomparable samples of normal subjects in whom neural injury and/orneural disorders, is undetectable. The control amount is measured underthe same or substantially similar experimental conditions as inmeasuring the test amount. For example, if a test sample is obtainedfrom a subject's cerebrospinal fluid and/or blood serum sample and amarker is detected using a particular probe, then a control amount ofthe marker is preferably determined from a serum sample of a patientusing the same probe. It is preferred that the control amount of markeris determined based upon a significant number of samples from normalsubjects who do not have neural injury and/or neuronal disorders so thatit reflects variations of the marker amounts in that population.

Data generated by mass spectrometry can then be analyzed by a computersoftware. The software can comprise code that converts signal from themass spectrometer into computer readable form. The software also caninclude code that applies an algorithm to the analysis of the signal todetermine whether the signal represents a “peak” in the signalcorresponding to a marker of this invention, or other useful markers.The software also can include code that executes an algorithm thatcompares signal from a test sample to a typical signal characteristic of“normal” and human neural injury and determines the closeness of fitbetween the two signals. The software also can include code indicatingwhich the test sample is closest to, thereby providing a probablediagnosis.

Production of Antibodies to Detect Neural Biomarkers

Neural biomarkers obtained from samples in patients suffering fromvarying neural injuries, degrees of severity of injury, neuronaldisorders and the like, can be prepared as described above. Furthermore,neural biomarkers can be subjected to enzymatic digestion to obtainfragments or peptides of the biomarkers for the production of antibodiesto different antigenic epitopes that can be present in a peptide versusthe whole protein. Antigenic epitopes are useful, for example, to raiseantibodies, including monoclonal antibodies, that specifically bind theepitope. Antigenic epitopes can be used as the target molecules inimmunoassays. (See, for instance, Wilson et al., Cell 37:767-778 (1984);Sutcliffe et al., Science 219:660-666 (1983)).

In a preferred embodiment, antibodies are directed to epitopes(specifically bind) of biomarkers Axonal Proteins: α II spectrin (andSPDB)-1, NF-68 (NF-L)-2, Tau-3, α II, III spectrin, NF-200 (NF-H),NF-160 (NF-M), Amyloid precursor protein, α internexin; DendriticProteins: beta III-tubulin-1, p24 microtubule-associated protein-2,alpha-Tubulin (P02551), beta-Tubulin (P04691), MAP-2A/B-3, MAP-2C-3,Stathmin-4, Dynamin-1 (P21575), Phocein, Dynactin (Q13561), Vimentin(P31000), Dynamin, Profilin, Cofilin 1,2; Somal Proteins: UCH-L1(Q00981)-1, Glycogen phosphorylase-BB-2, PEBP (P31044), NSE (P07323),CK-BB (P07335), Thy 1.1, Prion protein, Huntingtin, 14-3-3 proteins(e.g. 14-3-3-epsolon (P42655)), SM22-α, Calgranulin AB, alpha-Synuclein(P37377), beta-Synuclein (Q63754), HNP 22; Neural nuclear proteins:NeuN-1, S/G(2) nuclear autoantigen (SG2NA), Huntingtin; PresynapticProteins: Synaptophysin-1, Synaptotagmin (P21707), Synaptojanin-1(Q62910), Synaptojanin-2, Synapsin1 (Synapsin-Ia), Synapsin2 (Q63537),Synapsin3, GAP43, Bassoon(NP_003449), Piccolo (aczonin) (NP_149015),Syntaxin, CRMP1, 2, Amphiphysin-1 (NP_001626), Amphiphysin-2(NP_647477); Post-Synaptic Proteins: PSD95-1, NMDA-receptor (and allsubtypes)-2, PSD93, AMPA-kainate receptor (all subtypes), mGluR (allsubtypes), Calmodulin dependent protein kinase II (CAMPK)-alpha, beta,gamma, CaMPK-IV, SNAP-25, a-/b-SNAP; Myelin-Oligodendrocyte: Myelinbasic protein (MBP) and fragments, Myelin proteolipid protein (PLP),Myelin Oligodendrocyte specific protein (MOSP), Myelin Oligodendrocyteglycoprotein (MOG), myelin associated protein (MAG), OligodendrocyteNS-1 protein; Glial Protein Biomarkers: GFAP (P47819), Protein disulfideisomerase (PDI)-P04785, Neurocalcin delta, S100beta; Microglia proteinBiomarkers: Iba1, OX-42, OX-8, OX-6, ED-1, PTPase (CD45), CD40, CD68,CD11b, Fractalkine (CX3CL1) and Fractalkine receptor (CX3CR1), 5-d-4antigen; Schwann cell markers: Schwann cell myelin protein; Glia Scar:Tenascin; Hippocampus: Stathmin, Hippocalcin, SCG10; Cerebellum:Purkinje cell protein-2 (Pcp2), Calbindin D9K, Calbindin D28K(NP_114190), Cerebellar CaBP, spot 35; Cerebrocortex: Cortexin-1(P60606), H-2Z1 gene product; Thalamus: CD15(3-fucosyl-N-acetyl-lactosamine) epitope; Hypothalamus: Orexin receptors(OX-1R and OX-2R)-appetite, Orexins (hypothalamus-specific peptides);Corpus callosum: MBP, MOG, PLP, MAG; Spinal Cord: Schwann cell myelinprotein; Striatum: Striatin, Rhes (Ras homolog enriched in striatum);Peripheral ganglia: Gadd45a; Peripherial nerve fiber(sensory+motor):Peripherin, Peripheral myelin protein 22 (AAH91499); OtherNeuron-specific proteins: PH8 (S Serotonergic Dopaminergic, PEP-19,Neurocalcin (NC), a neuron-specific EF-hand Ca²⁺-binding protein,Encephalopsin, Striatin, SG2NA, Zinedin, Recoverin, Visinin;Neurotransmitter Receptors: NMDA receptor subunits (e.g. NR1A2B),Glutamate receptor subunits (AMPA, Kainate receptors (e.g. GluR1,GluR4), beta-adrenoceptor subtypes (e.g. beta(2)), Alpha-adrenoceptorssubtypes (e.g. alpha(2c)), GABA receptors (e.g. GABA(B)), Metabotropicglutamate receptor (e.g. mGluR3), 5-HT serotonin receptors (e.g.5-HT(3)), Dopamine receptors (e.g. D4), Muscarinic Ach receptors (e.g.M1), Nicotinic Acetylcholine Receptor (e.g. alpha-7); NeurotransmitterTransporters: Norepinephrine Transporter (NET), Dopamine transporter(DAT), Serotonin transporter (SERT), Vesicular transporter proteins(VMAT1 and VMAT2), GABA transporter vesicular inhibitory amino acidtransporter (VIAAT/VGAT), Glutamate Transporter (e.g. GLT1), Vesicularacetylcholine transporter, Vesicular Glutamate Transporter 1, [VGLUT1;BNPI] and VGLUT2, Choline transporter, (e.g. CHT1); CholinergicBiomarkers: Acetylcholine Esterase, Choline acetyltransferase [ChAT];Dopaminergic Biomarkers: Tyrosine Hydroxylase (TH), Phospho-TH, DARPP32;Noradrenergic Biomarkers: Dopamine beta-hydroxylase (DbH); AdrenergicBiomarkers: Phenylethanolamine N-methyltransferase (PNMT); SerotonergicBiomarkers: Tryptophan Hydroxylase (TrH); Glutamatergic Biomarkers:Glutaminase, Glutamine synthetase; GABAergic Biomarkers: GABAtransaminase [GABAT]), GAB A-B-R2.

In another preferred embodiment, the antibodies of the invention bind toat least one biomarker from each neural cell type. The composition ofbiomarkers is diagnostic of neural injury, damage and/or neuraldisorders. The composition comprises: α II spectrin, SPDB-1, NF-68,NF-L-2, Tau-3, βIII-tubulin-1, p24 microtubule-associated protein-2,UCH-L1 (Q00981)-1, Glycogen phosphorylase-BB-2, NeuN-1, Synaptophysin-1,synaptotagmin (P21707), Synaptojanin-1 (Q62910), Synaptojanin-2,PSD95-1, NMDA-receptor-2 and subtypes, myelin basic protein (MBP) andfragments, GFAP (P47819), Iba1, OX-42, OX-8, OX-6, ED-1, Schwann cellmyelin protein, tenascin, stathmin, Purkinje cell protein-2 (Pcp2),Cortexin-1 (P60606), Orexin receptors (OX-1R, OX-2R), Striatin, Gadd45a,Peripherin, peripheral myelin protein 22 (AAH91499), and Neurocalcin(NC).

Neural biomarker epitopes can be used, for example, to induce antibodiesaccording to methods well known in the art. (See, for instance,Sutcliffe et al., supra; Wilson et al., supra; Chow et al., Proc. Natl.Acad. Sci. USA 82:910-914; and Bittle et al., J. Gen. Virol.66:2347-2354 (1985). Neural polypeptides comprising one or moreimmunogenic epitopes may be presented for eliciting an antibody responsetogether with a carrier protein, such as an albumin, to an animal system(such as rabbit or mouse), or, if the polypeptide is of sufficientlength (at least about 25 amino acids), the polypeptide may be presentedwithout a carrier. However, immunogenic epitopes comprising as few as 3to 10 amino acids have been shown to be sufficient to raise antibodiescapable of binding to, at the very least, linear epitopes in a denaturedpolypeptide (e.g., in Western blotting).

Epitope-bearing polypeptides of the present invention may be used toinduce antibodies according to methods well known in the art including,but not limited to, in vivo immunization, in vitro immunization, andphage display methods. See, e.g., Sutcliffe et al., supra; Wilson etal., supra, and Bittle et al., J. Gen. Virol., 66:2347-2354 (1985). Ifin vivo immunization is used, animals may be immunized with freepeptide; however, anti-peptide antibody titer may be boosted by couplingthe peptide to a macromolecular carrier, such as keyhole limpethemacyanin (KLH) or tetanus toxoid. For instance, peptides containingcysteine residues may be coupled to a carrier using a linker such asmaleimidobenzoyl-N-hydroxysuccinimide ester (MBS), while other peptidesmay be coupled to carriers using a more general linking agent such asglutaraldehyde. Animals such as rabbits, rats and mice are immunizedwith either free or carrier-coupled peptides, for instance, byintraperitoneal and/or intradermal injection of emulsions containingabout 100 μg of peptide or carrier protein and Freund's adjuvant or anyother adjuvant known for stimulating an immune response. Several boosterinjections may be needed, for instance, at intervals of about two weeks,to provide a useful titer of anti-peptide antibody which can bedetected, for example, by ELISA assay using free peptide adsorbed to asolid surface. The titer of anti-peptide antibodies in serum from animmunized animal may be increased by selection of anti-peptideantibodies, for instance, by adsorption to the peptide on a solidsupport and elution of the selected antibodies according to methods wellknown in the art.

Nucleic acids neural biomarker epitopes can also be recombined with agene of interest as an epitope tag (e.g., the hemagglutinin (“HA”) tagor flag tag) to aid in detection and purification of the expressedpolypeptide. For example, a system described by Janknecht et al. allowsfor the ready purification of non-denatured fusion proteins expressed inhuman cell lines (Janknecht et al., 1991, Proc. Natl. Acad. Sci. USA88:8972-8976). In this system, the gene of interest is subcloned into avaccinia recombination plasmid such that the open reading frame of thegene is translationally fused to an amino-terminal tag consisting of sixhistidine residues. The tag serves as a matrix binding domain for thefusion protein. Extracts from cells infected with the recombinantvaccinia virus are loaded onto Ni²⁺ nitriloacetic acid-agarose columnand histidine-tagged proteins can be selectively eluted withimidazole-containing buffers.

The antibodies of the present invention may be generated by any suitablemethod known in the art. The antibodies of the present invention cancomprise polyclonal antibodies. Methods of preparing polyclonalantibodies are known to the skilled artisan (Harlow, et al., Antibodies:A Laboratory Manual, (Cold spring Harbor Laboratory Press, 2^(nd) ed.(1988), which is hereby incorporated herein by reference in itsentirety). For example, a polypeptide of the invention can beadministered to various host animals including, but not limited to,rabbits, mice, rats, etc. to induce the production of sera containingpolyclonal antibodies specific for the antigen. The administration ofthe polypeptides of the present invention may entail one or moreinjections of an immunizing agent and, if desired, an adjuvant. Variousadjuvants may be used to increase the immunological response, dependingon the host species, and include but are not limited to, Freund's(complete and incomplete), mineral gels such as aluminum hydroxide,surface active substances such as lysolecithin, pluronic polyols,polyanions, peptides, oil emulsions, keyhole limpet hemocyanins,dinitrophenol, and potentially useful human adjuvants such as BCG(bacille Calmette-Guerin) and Corynebacterium parvum. Such adjuvants arealso well known in the art. For the purposes of the invention,“immunizing agent” may be defined as a polypeptide of the invention,including fragments, variants, and/or derivatives thereof, in additionto fusions with heterologous polypeptides and other forms of thepolypeptides as may be described herein.

Typically, the immunizing agent and/or adjuvant will be injected in themammal by multiple subcutaneous or intraperitoneal injections, thoughthey may also be given intramuscularly, and/or through IV. Theimmunizing agent may include polypeptides of the present invention or afusion protein or variants thereof. Depending upon the nature of thepolypeptides (i.e., percent hydrophobicity, percent hydrophilicity,stability, net charge, isoelectric point etc.), it may be useful toconjugate the immunizing agent to a protein known to be immunogenic inthe mammal being immunized. Such conjugation includes either chemicalconjugation by derivatizing active chemical functional groups to boththe polypeptide of the present invention and the immunogenic proteinsuch that a covalent bond is formed, or through fusion-protein basedmethodology, or other methods known to the skilled artisan. Examples ofsuch immunogenic proteins include, but are not limited to keyhole limpethemocyanin, serum albumin, bovine thyroglobulin, and soybean trypsininhibitor. Various adjuvants may be used to increase the immunologicalresponse, depending on the host species, including but not limited toFreund's (complete and incomplete), mineral gels such as aluminumhydroxide, surface active substances such as lysolecithin, pluronicpolyols, polyanions, peptides, oil emulsions, keyhole limpet hemocyanin,dinitrophenol, and potentially useful human adjuvants such as BCG(bacille Calmette-Guerin) and Corynebacterium parvum. Additionalexamples of adjuvants which may be employed includes the MPL-TDMadjuvant (monophosphoryl lipid A, synthetic trehalose dicorynomycolate).The immunization protocol may be selected by one skilled in the artwithout undue experimentation.

The antibodies of the present invention can also comprise monoclonalantibodies. Monoclonal antibodies may be prepared using hybridomamethods, such as those described by Kohler and Milstein, Nature, 256:495(1975) and U.S. Pat. No. 4,376,110, by Harlow, et al., Antibodies: ALaboratory Manual, (Cold spring Harbor Laboratory Press, 2^(nd) ed.(1988), by Hammerling, et al., Monoclonal Antibodies and T-CellHybridomas (Elsevier, N.Y., (1981)), or other methods known to theartisan. Other examples of methods which may be employed for producingmonoclonal antibodies includes, but are not limited to, the human B-cellhybridoma technique (Kosbor et al., 1983, Immunology Today 4:72; Cole etal., 1983, Proc. Natl. Acad. Sci. USA 80:2026-2030), and theEBV-hybridoma technique (Cole et al., 1985, Monoclonal Antibodies AndCancer Therapy, Alan R. Liss, Inc., pp. 77-96). Such antibodies may beof any immunoglobulin class including IgG, IgM, IgE, IgA, IgD and anysubclass thereof. The hybridoma producing the mAb of this invention maybe cultivated in vitro or in vivo. Production of high titers of mAbs invivo makes this the presently preferred method of production.

In a hybridoma method, a mouse, a humanized mouse, a mouse with a humanimmune system, hamster, or other appropriate host animal, is typicallyimmunized with an immunizing agent to elicit lymphocytes that produce orare capable of producing antibodies that will specifically bind to theimmunizing agent. Alternatively, the lymphocytes may be immunized invitro.

The immunizing agent will typically include neural polypeptides,fragments or a fusion protein thereof. Generally, either peripheralblood lymphocytes (“PBLs”) are used if cells of human origin aredesired, or spleen cells or lymph node cells are used if non-humanmammalian sources are desired. The lymphocytes are then fused with animmortalized cell line using a suitable fusing agent, such aspolyethylene glycol, to form a hybridoma cell (Goding, MonoclonalAntibodies: Principles and Practice, Academic Press, (1986), pp.59-103). Immortalized cell lines are usually transformed mammaliancells, particularly myeloma cells of rodent, bovine and human origin.Usually, rat or mouse myeloma cell lines are employed. The hybridomacells may be cultured in a suitable culture medium that preferablycontains one or more substances that inhibit the growth or survival ofthe unfused, immortalized cells. For example, if the parental cells lackthe enzyme hypoxanthine guanine phosphoribosyl transferase (HGPRT orHPRT), the culture medium for the hybridomas typically will includehypoxanthine, aminopterin, and thymidine (“HAT medium”), whichsubstances prevent the growth of HGPRT-deficient cells.

Preferred immortalized cell lines are those that fuse efficiently,support stable high level expression of antibody by the selectedantibody-producing cells, and are sensitive to a medium such as HATmedium. More preferred immortalized cell lines are murine myeloma lines,which can be obtained, for instance, from the Salk Institute CellDistribution Center, San Diego, Calif. and the American Type CultureCollection, Manassas, Va. As inferred throughout the specification,human myeloma and mouse-human heteromyeloma cell lines also have beendescribed for the production of human monoclonal antibodies (Kozbor, J.Immunol., 133:3001 (1984); Brodeur et al., Monoclonal AntibodyProduction Techniques and Applications, Marcel Dekker, Inc., New York,(1987) pp. 51-63).

The culture medium in which the hybridoma cells are cultured can then beassayed for the presence of monoclonal antibodies directed against theneural polypeptides of the present invention. Preferably, the bindingspecificity of monoclonal antibodies produced by the hybridoma cells isdetermined by immunoprecipitation or by an in vitro binding assay, suchas radioimmunoassay (MA) or enzyme-linked immunoadsorbant assay (ELISA).Such techniques are known in the art and within the skill of theartisan. The binding affinity of the monoclonal antibody can, forexample, be determined by the Scatchard analysis of Munson and Pollart,Anal. Biochem., 107:220 (1980).

After the desired hybridoma cells are identified, the clones may besubcloned by limiting dilution procedures and grown by standard methods(Goding, supra). Suitable culture media for this purpose include, forexample, Dulbecco's Modified Eagle's Medium and RPMI-1640.Alternatively, the hybridoma cells may be grown in vivo as ascites in amammal.

The monoclonal antibodies secreted by the subclones may be isolated orpurified from the culture medium or ascites fluid by conventionalimmunoglobulin purification procedures such as, for example, proteinA-sepharose, hydroxyapatite chromatography, gel exclusionchromatography, gel electrophoresis, dialysis, or affinitychromatography.

The skilled artisan would acknowledge that a variety of methods exist inthe art for the production of monoclonal antibodies and thus, theinvention is not limited to their sole production in hybridomas. Forexample, the monoclonal antibodies may be made by recombinant DNAmethods, such as those described in U.S. Pat. No. 4,816,567. In thiscontext, the term “monoclonal antibody” refers to an antibody derivedfrom a single eukaryotic, phage, or prokaryotic clone. The DNA encodingthe monoclonal antibodies of the invention can be readily isolated andsequenced using conventional procedures (e.g., by using oligonucleotideprobes that are capable of binding specifically to genes encoding theheavy and light chains of murine antibodies, or such chains from human,humanized, or other sources). The hybridoma cells of the invention serveas a preferred source of such DNA. Once isolated, the DNA may be placedinto expression vectors, which are then transformed into host cells suchas Simian COS cells, Chinese hamster ovary (CHO) cells, or myeloma cellsthat do not otherwise produce immunoglobulin protein, to obtain thesynthesis of monoclonal antibodies in the recombinant host cells.

Methods for producing and screening for specific antibodies usinghybridoma technology are routine and well known in the art. In anon-limiting example, mice can be immunized with a biomarker polypeptideor a cell expressing such peptide. Once an immune response is detected,e.g., antibodies specific for the antigen are detected in the mouseserum, the mouse spleen is harvested and splenocytes isolated. Thesplenocytes are then fused by well-known techniques to any suitablemyeloma cells, for example cells from cell line SP20 available from theATCC. Hybridomas are selected and cloned by limited dilution. Thehybridoma clones are then assayed by methods known in the art for cellsthat secrete antibodies capable of binding a polypeptide of theinvention. Ascites fluid, which generally contains high levels ofantibodies, can be generated by immunizing mice with positive hybridomaclones.

Accordingly, the present invention provides methods of generatingmonoclonal antibodies as well as antibodies produced by the methodcomprising culturing a hybridoma cell secreting an antibody of theinvention wherein, preferably, the hybridoma is generated by fusingsplenocytes isolated from a mouse immunized with an antigen of theinvention with myeloma cells and then screening the hybridomas resultingfrom the fusion for hybridoma clones that secrete an antibody able tobind a polypeptide of the invention. The antibodies detecting neuralbiomarkers, peptides and derivatives thereof, can be used inimmunoassays and other methods to identify new neural biomarkers and foruse in the diagnosis of neural injury, degree of severity of injuryand/or neurological disorders.

Other methods can also be used for the large scale production of neuralbiomarker specific antibodies. For example, antibodies can also begenerated using various phage display methods known in the art. In phagedisplay methods, functional antibody domains are displayed on thesurface of phage particles which carry the polynucleotide sequencesencoding them. In a particular embodiment, such phage can be utilized todisplay antigen binding domains expressed from a repertoire orcombinatorial antibody library (e.g., human or murine). Phage expressingan antigen binding domain that binds the antigen of interest can beselected or identified with antigen, e.g., using labeled antigen orantigen bound or captured to a solid surface or bead. Phage used inthese methods are typically filamentous phage including fd and M13binding domains expressed from phage with Fab, Fv or disulfidestabilized Fv antibody domains recombinantly fused to either the phagegene III or gene VIII protein. Examples of phage display methods thatcan be used to make the antibodies of the present invention includethose disclosed in Brinkman et al., J. Immunol. Methods 182:41-50(1995); Ames et al., J. Immunol. Methods 184:177-186 (1995);Kettleborough et al., Eur. J. Immunol. 24:952-958 (1994); Persic et al.,Gene 187 9-18 (1997); Burton et al., Advances in Immunology 57:191-280(1994); PCT application No. PCT/GB91/01134; PCT publications WO90/02809; WO 91/10737; WO 92/01047; WO 92/18619; WO 93/11236; WO95/15982; WO 95/20401; and U.S. Pat. Nos. 5,698,426; 5,223,409;5,403,484; 5,580,717; 5,427,908; 5,750,753; 5,821,047; 5,571,698;5,427,908; 5,516,637; 5,780,225; 5,658,727; 5,733,743 and 5,969,108;each of which is incorporated herein by reference in its entirety.

The antibodies of the present invention have various utilities. Forexample, such antibodies may be used in diagnostic assays to detect thepresence or quantification of the polypeptides of the invention in asample. Such a diagnostic assay can comprise at least two steps. Thefirst, subjecting a sample with the antibody, wherein the sample is atissue (e.g., human, animal, etc.), biological fluid (e.g., blood,urine, sputum, semen, amniotic fluid, saliva, etc.), biological extract(e.g., tissue or cellular homogenate, etc.), a protein microchip (e.g.,See Arenkov P, et al., Anal Biochem., 278(2):123-131 (2000)), or achromatography column, etc. And a second step involving thequantification of antibody bound to the substrate. Alternatively, themethod may additionally involve a first step of attaching the antibody,either covalently, electrostatically, or reversibly, to a solid support,and a second step of subjecting the bound antibody to the sample, asdefined above and elsewhere herein.

Various diagnostic assay techniques are known in the art, such ascompetitive binding assays, direct or indirect sandwich assays andimmunoprecipitation assays conducted in either heterogeneous orhomogenous phases (Zola, Monoclonal Antibodies: A Manual of Techniques,CRC Press, Inc., (1987), pp 147-158). The antibodies used in thediagnostic assays can be labeled with a detectable moiety. Thedetectable moiety should be capable of producing, either directly orindirectly, a detectable signal. For example, the detectable moiety maybe a radioisotope, such as ²H, ¹⁴C, ³²P, or ¹²⁵I, a florescent orchemiluminescent compound, such as fluorescein isothiocyanate,rhodamine, or luciferin, or an enzyme, such as alkaline phosphatase,beta-galactosidase, green fluorescent protein, or horseradishperoxidase. Any method known in the art for conjugating the antibody tothe detectable moiety may be employed, including those methods describedby Hunter et al., Nature, 144:945 (1962); David et al., Biochem.,13:1014 (1974); Pain et al., J. Immunol. Methods, 40:219(1981); andNygren, J. Histochem. and Cytochem., 30:407 (1982).

Kits

In yet another aspect, the invention provides kits for aiding adiagnosis of neural injury, degree of severity of injury, subcellularlocalization and/or neuronal disorders, wherein the kits can be used todetect the markers of the present invention. For example, the kits canbe used to detect any one or more of the markers described herein, whichmarkers are differentially present in samples of a patient and normalsubjects. The kits of the invention have many applications. For example,the kits can be used to differentiate if a subject has axonal injuryversus, for example, dendritic, or has a negative diagnosis, thus aidingneuronal injury diagnosis. In another example, the kits can be used toidentify compounds that modulate expression of one or more of themarkers in in vitro or in vivo animal models to determine the effects oftreatment.

In one embodiment, a kit comprises (a) an antibody that specificallybinds to a marker; and (b) a detection reagent. Such kits can beprepared from the materials described above, and the previous discussionregarding the materials (e.g., antibodies, detection reagents,immobilized supports, etc.) is fully applicable to this section and willnot be repeated. Optionally, the kit may further comprisepre-fractionation spin columns. In some embodiments, the kit may furthercomprise instructions for suitable operation parameters in the form of alabel or a separate insert.

In another embodiment, the kit comprises (a) a panel or composition ofbiomarkers (b) a detecting agent. The panel or composition of biomarkersincluded in a kit include at least one biomarker and/or a plurality ofbiomarkers in order to diagnose in vivo location of neural injury. Thesebiomarkers include: Axonal Proteins: α II spectrin (and SPDB)-1, NF-68(NF-L)-2, Tau-3, α II, III spectrin, NF-200 (NF-H), NF-160 (NF-M),Amyloid precursor protein, α internexin; Dendritic Proteins: betaIII-tubulin-1, p24 microtubule-associated protein-2, alpha-Tubulin(P02551), beta-Tubulin (P04691), MAP-2A/B-3, MAP-2C-3, Stathmin-4,Dynamin-1 (P21575), Phocein, Dynactin (Q13561), Vimentin (P31000),Dynamin, Profilin, Cofilin 1,2; Somal Proteins: UCH-L1 (Q00981)-1,Glycogen phosphorylase-BB-2, PEBP (P31044), NSE (P07323), CK-BB(P07335), Thy 1.1, Prion protein, Huntingtin, 14-3-3 proteins (e.g.14-3-3-epsolon (P42655)), SM22-α, Calgranulin AB, alpha-Synuclein(P37377), beta-Synuclein (Q63754), HNP 22; Neural nuclear proteins:NeuN-1, S/G(2) nuclear autoantigen (SG2NA), Huntingtin; PresynapticProteins: Synaptophysin-1, Synaptotagmin (P21707), Synaptojanin-1(Q62910), Synaptojanin-2, Synapsin1 (Synapsin-Ia), Synapsin2 (Q63537),Synapsin3, GAP43, Bassoon(NP_003449), Piccolo (aczonin) (NP_149015),Syntaxin, CRMP1, 2, Amphiphysin-1 (NP_001626), Amphiphysin-2(NP_647477); Post-Synaptic Proteins: PSD95-1, NMDA-receptor (and allsubtypes)-2, PSD93, AMPA-kainate receptor (all subtypes), mGluR (allsubtypes), Calmodulin dependent protein kinase II (CAMPK)-alpha, beta,gamma, CaMPK-IV, SNAP-25, a-/b-SNAP; Myelin-Oligodendrocyte: Myelinbasic protein (MBP) and fragments, Myelin proteolipid protein (PLP),Myelin Oligodendrocyte specific protein (MOSP), Myelin Oligodendrocyteglycoprotein (MOG), myelin associated protein (MAG), OligodendrocyteNS-1 protein; Glial Protein Biomarkers: GFAP (P47819), Protein disulfideisomerase (PDI)-P04785, Neurocalcin delta, S100beta; Microglia proteinBiomarkers: Iba1, OX-42, OX-8, OX-6, ED-1, PTPase (CD45), CD40, CD68,CD11b, Fractalkine (CX3CL1) and Fractalkine receptor (CX3CR1), 5-d-4antigen; Schwann cell markers: Schwann cell myelin protein; Glia Scar:Tenascin; Hippocampus: Stathmin, Hippocalcin, SCG10; Cerebellum:Purkinje cell protein-2 (Pcp2), Calbindin D9K, Calbindin D28K(NP_114190), Cerebellar CaBP, spot 35; Cerebrocortex: Cortexin-1(P60606), H-2Z1 gene product; Thalamus: CD15(3-fucosyl-N-acetyl-lactosamine) epitope; Hypothalamus: Orexin receptors(OX-1R and OX-2R)-appetite, Orexins (hypothalamus-specific peptides);Corpus callosum: MBP, MOG, PLP, MAG; Spinal Cord: Schwann cell myelinprotein; Striatum: Striatin, Rhes (Ras homolog enriched in striatum);Peripheral ganglia: Gadd45a; Peripherial nerve fiber(sensory+motor):Peripherin, Peripheral myelin protein 22 (AAH91499); OtherNeuron-specific proteins: PH8 (S Serotonergic Dopaminergic, PEP-19,Neurocalcin (NC), a neuron-specific EF-hand Ca²⁺-binding protein,Encephalopsin, Striatin, SG2NA, Zinedin, Recoverin, Visinin;Neurotransmitter Receptors: NMDA receptor subunits (e.g. NR1A2B),Glutamate receptor subunits (AMPA, Kainate receptors (e.g. GluR1,GluR4), beta-adrenoceptor subtypes (e.g. beta(2)), Alpha-adrenoceptorssubtypes (e.g. alpha(2c)), GABA receptors (e.g. GABA(B)), Metabotropicglutamate receptor (e.g. mGluR3), 5-HT serotonin receptors (e.g.5-HT(3)), Dopamine receptors (e.g. D4), Muscarinic Ach receptors (e.g.M1), Nicotinic Acetylcholine Receptor (e.g. alpha-7); NeurotransmitterTransporters: Norepinephrine Transporter (NET), Dopamine transporter(DAT), Serotonin transporter (SERT), Vesicular transporter proteins(VMAT1 and VMAT2), GABA transporter vesicular inhibitory amino acidtransporter (VIAAT/VGAT), Glutamate Transporter (e.g. GLT1), Vesicularacetylcholine transporter, Vesicular Glutamate Transporter 1, [VGLUT1;BNPI] and VGLUT2, Choline transporter, (e.g. CHT1); CholinergicBiomarkers: Acetylcholine Esterase, Choline acetyltransferase [ChAT];Dopaminergic Biomarkers: Tyrosine Hydroxylase (TH), Phospho-TH, DARPP32;Noradrenergic Biomarkers: Dopamine beta-hydroxylase (DbH); AdrenergicBiomarkers: Phenylethanolamine N-methyltransferase (PNMT); SerotonergicBiomarkers: Tryptophan Hydroxylase (TrH); Glutamatergic Biomarkers:Glutaminase, Glutamine synthetase; GABAergic Biomarkers: GABAtransaminase [GABAT]), GAB A-B-R2.

In another preferred embodiment, the panel of biomarkers in a kit atleast one biomarker from each neural cell type. The composition ofbiomarkers is diagnostic of neural injury, damage and/or neuraldisorders. The composition comprises: α II spectrin, SPDB-1, NF-68,NF-L-2, Tau-3, βIII-tubulin-1, p24 microtubule-associated protein-2,UCH-L1 (Q00981)-1, Glycogen phosphorylase-BB-2, NeuN-1, Synaptophysin-1,synaptotagmin (P21707), Synaptojanin-1 (Q62910), Synaptojanin-2,PSD95-1, NMDA-receptor-2 and subtypes, myelin basic protein (MBP) andfragments, GFAP (P47819), Iba1, OX-42, OX-8, OX-6, ED-1, Schwann cellmyelin protein, tenascin, stathmin, Purkinje cell protein-2 (Pcp2),Cortexin-1 (P60606), Orexin receptors (OX-1R, OX-2R), Striatin, Gadd45a,Peripherin, peripheral myelin protein 22 (AAH91499), and Neurocalcin(NC).

In another preferred embodiment, the antibodies in a kit are specificfor a panel of biomarkers and one or more antibodies can be used.Antibodies are specific for biomarkers: Axonal Proteins: α II spectrin(and SPDB)-1, NF-68 (NF-L)-2, Tau-3, α II, III spectrin, NF-200 (NF-H),NF-160 (NF-M), Amyloid precursor protein, α internexin; DendriticProteins: beta III-tubulin-1, p24 microtubule-associated protein-2,alpha-Tubulin (P02551), beta-Tubulin (P04691), MAP-2A/B-3, MAP-2C-3,Stathmin-4, Dynamin-1 (P21575), Phocein, Dynactin (Q13561), Vimentin(P31000), Dynamin, Profilin, Cofilin 1,2; Somal Proteins: UCH-L1(Q00981)-1, Glycogen phosphorylase-BB-2, PEBP (P31044), NSE (P07323),CK-BB (P07335), Thy 1.1, Prion protein, Huntingtin, 14-3-3 proteins(e.g. 14-3-3-epsolon (P42655)), SM22-α, Calgranulin AB, alpha-Synuclein(P37377), beta-Synuclein (Q63754), HNP_22; Neural nuclear proteins:NeuN-1, S/G(2) nuclear autoantigen (SG2NA), Huntingtin; PresynapticProteins: Synaptophysin-1, Synaptotagmin (P21707), Synaptojanin-1(Q62910), Synaptojanin-2, Synapsin1 (Synapsin-Ia), Synapsin2 (Q63537),Synapsin3, GAP43, Bassoon(NP_003449), Piccolo (aczonin) (NP_149015),Syntaxin, CRMP1, 2, Amphiphysin-1 (NP_001626), Amphiphysin-2(NP_647477); Post-Synaptic Proteins: PSD95-1, NMDA-receptor (and allsubtypes)-2, PSD93, AMPA-kainate receptor (all subtypes), mGluR (allsubtypes), Calmodulin dependent protein kinase II (CAMPK)-alpha, beta,gamma, CaMPK-IV, SNAP-25, a-/b-SNAP; Myelin-Oligodendrocyte: Myelinbasic protein (MBP) and fragments, Myelin proteolipid protein (PLP),Myelin Oligodendrocyte specific protein (MOSP), Myelin Oligodendrocyteglycoprotein (MOG), myelin associated protein (MAG), OligodendrocyteNS-1 protein; Glial Protein Biomarkers: GFAP (P47819), Protein disulfideisomerase (PDI)-P04785, Neurocalcin delta, S100beta; Microglia proteinBiomarkers: Iba1, OX-42, OX-8, OX-6, ED-1, PTPase (CD45), CD40, CD68,CD11b, Fractalkine (CX3CL1) and Fractalkine receptor (CX3CR1), 5-d-4antigen; Schwann cell markers: Schwann cell myelin protein; Glia Scar:Tenascin; Hippocampus: Stathmin, Hippocalcin, SCG10; Cerebellum:Purkinje cell protein-2 (Pcp2), Calbindin D9K, Calbindin D28K(NP_114190), Cerebellar CaBP, spot 35; Cerebrocortex: Cortexin-1(P60606), H-2Z1 gene product; Thalamus: CD15(3-fucosyl-N-acetyl-lactosamine) epitope; Hypothalamus: Orexin receptors(OX-1R and OX-2R)-appetite, Orexins (hypothalamus-specific peptides);Corpus callosum: MBP, MOG, PLP, MAG; Spinal Cord: Schwann cell myelinprotein; Striatum: Striatin, Rhes (Ras homolog enriched in striatum);Peripheral ganglia: Gadd45a; Peripherial nerve fiber(sensory+motor):Peripherin, Peripheral myelin protein 22 (AAH91499); OtherNeuron-specific proteins: PH8 (S Serotonergic Dopaminergic, PEP-19,Neurocalcin (NC), a neuron-specific EF-hand Ca²⁺-binding protein,Encephalopsin, Striatin, SG2NA, Zinedin, Recoverin, Visinin;Neurotransmitter Receptors: NMDA receptor subunits (e.g. NR1A2B),Glutamate receptor subunits (AMPA, Kainate receptors (e.g. GluR1,GluR4), beta-adrenoceptor subtypes (e.g. beta(2)), Alpha-adrenoceptorssubtypes (e.g. alpha(2c)), GABA receptors (e.g. GABA(B)), Metabotropicglutamate receptor (e.g. mGluR3), 5-HT serotonin receptors (e.g.5-HT(3)), Dopamine receptors (e.g. D4), Muscarinic Ach receptors (e.g.M1), Nicotinic Acetylcholine Receptor (e.g. alpha-7); NeurotransmitterTransporters: Norepinephrine Transporter (NET), Dopamine transporter(DAT), Serotonin transporter (SERT), Vesicular transporter proteins(VMAT1 and VMAT2), GABA transporter vesicular inhibitory amino acidtransporter (VIAAT/VGAT), Glutamate Transporter (e.g. GLT1), Vesicularacetylcholine transporter, Vesicular Glutamate Transporter 1, [VGLUT1;BNPI] and VGLUT2, Choline transporter, (e.g. CHT1); CholinergicBiomarkers: Acetylcholine Esterase, Choline acetyltransferase [ChAT];Dopaminergic Biomarkers: Tyrosine Hydroxylase (TH), Phospho-TH, DARPP32;Noradrenergic Biomarkers: Dopamine beta-hydroxylase (DbH); AdrenergicBiomarkers: Phenylethanolamine N-methyltransferase (PNMT); SerotonergicBiomarkers: Tryptophan Hydroxylase (TrH); Glutamatergic Biomarkers:Glutaminase, Glutamine synthetase; GABAergic Biomarkers: GABAtransaminase [GABAT]), GAB A-B-R2.

In another preferred embodiment, the antibodies are specific for atleast one biomarker from each neural cell type. The composition ofbiomarkers is diagnostic of neural injury, damage and/or neuraldisorders. The antibodies bind to: α II spectrin, SPDB-1, NF-68, NF-L-2,Tau-3, βIII-tubulin-1, p24 microtubule-associated protein-2, UCH-L1(Q00981)-1, Glycogen phosphorylase-BB-2, NeuN-1, Synaptophysin-1,synaptotagmin (P21707), Synaptojanin-1 (Q62910), Synaptojanin-2,PSD95-1, NMDA-receptor-2 and subtypes, myelin basic protein (MBP) andfragments, GFAP (P47819), Iba1, OX-42, OX-8, OX-6, ED-1, Schwann cellmyelin protein, tenascin, stathmin, Purkinje cell protein-2 (Pcp2),Cortexin-1 (P60606), Orexin receptors (OX-1R, OX-2R), Striatin, Gadd45a,Peripherin, peripheral myelin protein 22 (AAH91499), and Neurocalcin(NC).

In an additional embodiment, the invention includes a diagnostic kit foruse in screening serum containing antigens of the polypeptide of theinvention. The diagnostic kit includes a substantially isolated antibodyspecifically immunoreactive with polypeptide or polynucleotide antigens,and means for detecting the binding of the polynucleotide or polypeptideantigen to the antibody. In one embodiment, the antibody is attached toa solid support. In a specific embodiment, the antibody may be amonoclonal antibody. The detecting means of the kit may include asecond, labeled monoclonal antibody. Alternatively, or in addition, thedetecting means may include a labeled, competing antigen.

In one diagnostic configuration, test serum is reacted with a solidphase reagent having a surface-bound antigen obtained by the methods ofthe present invention. After binding with specific antigen antibody tothe reagent and removing unbound serum components by washing, thereagent is reacted with reporter-labeled anti-human antibody to bindreporter to the reagent in proportion to the amount of boundanti-antigen antibody on the solid support. The reagent is again washedto remove unbound labeled antibody, and the amount of reporterassociated with the reagent is determined. Typically, the reporter is anenzyme which is detected by incubating the solid phase in the presenceof a suitable fluorometric, luminescent or colorimetric substrate(Sigma, St. Louis, Mo.).

The solid surface reagent in the above assay is prepared by knowntechniques for attaching protein material to solid support material,such as polymeric beads, dip sticks, 96-well plate or filter material.These attachment methods generally include non-specific adsorption ofthe protein to the support or covalent attachment of the protein,typically through a free amine group, to a chemically reactive group onthe solid support, such as an activated carboxyl, hydroxyl, or aldehydegroup. Alternatively, streptavidin coated plates can be used inconjunction with biotinylated antigen(s).

Optionally, the kit may further comprise a standard or controlinformation so that the test sample can be compared with the controlinformation standard to determine if the test amount of a markerdetected in a sample is a diagnostic amount consistent with a diagnosisof neural injury, degree of severity of the injury, subcellularlocalization, neuronal disorder and/or effect of treatment on thepatient.

In another embodiment, a kit comprises: (a) a substrate comprising anadsorbent thereon, wherein the adsorbent is suitable for binding amarker, and (b) instructions to detect the marker or markers bycontacting a sample with the adsorbent and detecting the marker ormarkers retained by the adsorbent. In some embodiments, the kit maycomprise an eluant (as an alternative or in combination withinstructions) or instructions for making an eluant, wherein thecombination of the adsorbent and the eluant allows detection of themarkers using gas phase ion spectrometry. Such kits can be prepared fromthe materials described above, and the previous discussion of thesematerials (e.g., probe substrates, adsorbents, washing solutions, etc.)is fully applicable to this section and will not be repeated.

In another embodiment, the kit may comprise a first substrate comprisingan adsorbent thereon (e.g., a particle functionalized with an adsorbent)and a second substrate onto which the first substrate can be positionedto form a probe which is removably insertable into a gas phase ionspectrometer. In other embodiments, the kit may comprise a singlesubstrate which is in the form of a removably insertable probe withadsorbents on the substrate. In yet another embodiment, the kit mayfurther comprise a pre-fractionation spin column (e.g., Cibacron blueagarose column, anti-HSA agarose column, size exclusion column, Q-anionexchange spin column, single stranded DNA column, lectin column, etc.).

Optionally, the kit can further comprise instructions for suitableoperational parameters in the form of a label or a separate insert. Forexample, the kit may have standard instructions informing a consumer howto wash the probe after a sample is contacted on the probe. In anotherexample, the kit may have instructions for pre-fractionating a sample toreduce complexity of proteins in the sample. In another example, the kitmay have instructions for automating the fractionation or otherprocesses.

The following examples are offered by way of illustration, not by way oflimitation. While specific examples have been provided, the abovedescription is illustrative and not restrictive. Any one or more of thefeatures of the previously described embodiments can be combined in anymanner with one or more features of any other embodiments in the presentinvention. Furthermore, many variations of the invention will becomeapparent to those skilled in the art upon review of the specification.The scope of the invention should, therefore, be determined not withreference to the above description, but instead should be determinedwith reference to the appended claims along with their full scope ofequivalents.

All publications and patent documents cited in this application areincorporated by reference in their entirety for all purposes to the sameextent as if each individual publication or patent document were soindividually denoted. By their citation of various references in thisdocument, Applicants do not admit any particular reference is “priorart” to their invention.

EXAMPLES

Materials and Methods

Abbreviations:

AEBSF, 4-(2-aminoethyl)-benzenesulfonylflouride; EDTA,ethylenediaminetetraacetic acid; EGTA, ethylenebis(oxyethylenenitrilo)tetra acetic acid; DMEM, Dulbecco's modified Eagle's medium; BSA, bovineserum albumin; DPBS, Dulbecco's phosphate buffered saline; DTT,dithiothreitol; FDA, fluorescein diacetate; GFAP, glial fibrillary acidprotein; HBSS, Hanks' balanced salt solution; MAP-2, microtubuleassociated protein-2; PI, propidium iodide; PMSF, phenylmethylsulfonylfluoride; SDS, sodium dedocyl sulfate; TEMED,N,N,N′,N′-tetramethyletheylenediamine; Calpinh-II, calpain inhibitor II(N-acetyl-Leu-Leu-methioninal); Z-D-DCB, pan-caspaseinhibitor(carbobenzoxy-Asp-CH₂—OC (O)-2-6-dichlorobenzene); PBS,phosphate buffered saline; TLCK, Nα-p-tosyl-L-Lysine chloro methyl;TPCK, N-tosyl-L-phenylalanine chloromethyl ketone.

Surgical Procedures

Controlled cortical impact traumatic brain injury. A cortical impactinjury device was used to produce TBI in rodents. Cortical impact TBIresults in cortical deformation within the vicinity of the impactor tipassociated with contusion, and neuronal and axonal damage that isconstrained in the hemisphere ipsilateral to the site of injury. Adultmale (280-300 g) Sprague-Dawley rats (Harlan; Indianapolis, Ind.) wereinitially anesthetized with 4% isoflurane in a carrier gas of 1:1 O₂/N₂O(4 min.) followed by maintenance anesthesia of 2.5% isoflurane in thesame carrier gas. Core body temperature was monitored continuously by arectal thermistor probe and maintained at 37±1° C. by placing anadjustable temperature controlled heating pad beneath the rats. Animalswere mounted in a stereotactic frame in a prone position and secured byear and incisor bars.

A midline cranial incision was made, the soft tissues were reflected,and a unilateral (ipsilateral to site of impact) craniotomy (7 mmdiameter) was performed adjacent to the central suture, midway betweenbregma and lambda. The dura mater was kept intact over the cortex. Braintrauma in rats was produced by impacting the right cortex (ipsilateralcortex) with a 5 mm diameter aluminum impactor tip (housed in apneumatic cylinder) at a velocity of 3.5 m/s with a 2.0 mm compressionand 150 ms dwell time (compression duration). Velocity was controlled byadjusting the pressure (compressed N₂) supplied to the pneumaticcylinder. Velocity and dwell time were measured by a linear velocitydisplacment transducer (Lucas Shaevitz™ model 500 HR; Detroit, Mich.)that produces an analogue signal that was recorded by a storage-traceoscilloscope (BK Precision, model 2522B; Placentia, Calif.).Sham-injured animals underwent identical surgical procedures but did notreceive an impact injury. Appropriate pre- and post-injury managementwas maintained.

Preparation of Cortical Tissue and CSF

CSF and brain cortices were collected from animals at various intervalsafter sham-injury or TBI. At the appropriate time-points, TBI orsham-injured animals were anesthetized as described above and secured ina stereotactic frame with the head allowed to move freely along thelongitudinal axis. The head was flexed so that the external occipitalprotuberance in the neck was prominent and a dorsal midline incision wasmade over the cervical vertebrae and occiput. The atlanto-occipitalmembrane was exposed by blunt dissection and a 25G needle attached topolyethylene tubing was carefully lowered into the cisterna magna.Approximately 0.1 to 0.15 ml of CSF was collected from each rat.Following CSF collection, animals were removed from the stereotacticframe and immediately killed by decapitation.

Ipsilateral and contralateral (to the impact site) cortices were thenrapidly dissected, rinsed in ice cold PBS, and snap frozen in liquidnitrogen. Cortices beneath the craniotomies were excised to the level ofthe white matter and extended ˜4 mm laterally and ˜7 mm rostrocaudally.CSF samples were centrifuged at 4000 g for 4 min. at 4° C. to clear anycontaminating erythrocytes. Cleared CSF and frozen tissue samples werestored at −80° C. until ready for use. Cortices were homogenized in aglass tube with a TEFLON dounce pestle in 15 volumes of an ice-coldtriple detergent lysis buffer (20 mM Hepes, 1 mM EDTA, 2 mM EGTA, 150 mMNaCl, 0.1% SDS, 1.0% IGEPAL 40, 0.5% deoxycholic acid, pH 7.5)containing a broad range protease inhibitor cocktail (Roche MolecularBiochemicals, cat. #1-836-145).

Human CSF samples were obtained with informed consent from humansubjects suffering from TBI, and from control patients without TBI,having hydrocephaly.

Sandwich ELISA.

Anti-Biomarker specific rabbit polyclonal antibody and monoclonalantibodies are produced in the laboratory. To determine reactivity andspecificity of the antibodies a tissue panel is probed by Western blot.An indirect ELISA is used with the recombinant biomarker proteinattached to the ELISA plate to determine the optimal concentrations ofthe antibodies used in the assay. This assay determines a robustconcentration of anti-biomarker to use in the assay. 96-well microplatewells are coated with 50 ng/well and the rabbit and mouse anti-biomarkerantibodies are diluted serially starting with a 1:250 dilution down to1:10,000 to determine the optimum concentration to use for the assay. Asecondary anti-rabbit (or mouse)-horseradish peroxidase (HRP) labeleddetection antibody and Ultra-TMB are used as detection substrate toevaluate the results.

Once the concentration of antibody for maximum signal are determined,maximum detection limit of the indirect ELISA for each antibody isdetermined. 96-well microplates are coated with a concentration from 50ng/well serially diluted to <1 pg/well. For detection antibodies arediluted to the concentration determined above. This provides asensitivity range for the Biomarker ELISA assays and determines whichantibody to chose for capture and detection antibody.

Optimization and enhancement of signal in the sandwich ELISA: Thedetection antibody is directly labeled with HRP to avoid any crossreactivity and to be able to enhance the signal with the amplificationsystem, which is very sensitive. This format is used in detecting allthe biomarkers. The wells of the 96-well plate are coated withsaturating concentrations of purified antibody (˜250 ng/well), theconcentration of biomarker antigen ranges from 50 ng to <1 pg/well andthe detection antibody is at the concentration determined above.Initially the complex is detected with a HRP-labeled secondary antibodyto confirm the SW ELISA format, and the detection system is replaced bythe HRP-labeled detection antibody.

Standard curves of biomarkers and samples from control and injuredanimals are used. This also determines parallelism between the serumsamples and the standard curve. Serum samples are spiked with a serialdilution of each biomarker, similar to the standard curve. Parallelresults are equal to 80-100% recovery. If any high concentrations ofserum have interfering substances, the minimum dilution required isdetermined to remove the interference. The assay is used to evaluatebiomarker levels in serum from injured animals having injuries ofdifferent magnitudes followed over time.

The ELISA has been developed and optimized as a standard 96-well formatELISA which is specific for the biomarkers and sensitivity in the rangemeasured in rat and human CSF and serum. Antibodies that recognize theUCH-L1 protein with high specificity and sensitivity (FIGS. 3 and 4)were used as capture and detection antibodies. The detection antibody islabeled with horseradish peroxidase (HRP) and colorimetric developmentis achieved using Ultra-TMB.

Validation of UCH-L1 as a Biomarker for TBI

Using rat and human samples obtained from the University of Florida(Gainesville, Fla. and Banyan Biomarkers, Alachua Fla.) has confirmedthat UCH-L1 is a reliable and sensitive biomarker for TBI. Rat CSF andserum samples were obtained from animals that had received anexperimental brain injury using controlled cortical impact. UCH-L1levels in CSF and serum (FIG. 9) were significantly higher in braininjured animals than they were in uninjured or sham-injured controls.Likewise, high levels of UCH-L1 can be measured in serum from humanpatients with brain injuries but are below the level of assay detectionin normal healthy people (FIG. 9).

Gel Electrophoresis and Immunoblot Analyses of CSF

Protein concentrations of CSF were determined by bicinchoninic acidmicroprotein assays (Pierce Inc., Rockford, Ill.) with albuminstandards. Protein balanced samples were prepared for sodium dodecylsulfate-polyacrylamide gel electrophoresis (SDS-PAGE) in twofold loadingbuffer containing 0.25 M Tris (pH 6.8), 0.2 M DTT, 8% SDS, 0.02%bromophenol blue, and 20% glycerol in distilled H₂O. Samples were heatedfor 2 min. at 90° C. and centrifuged for 1 min. at 10,000 rpm in amicrocentrifuge at ambient temperature. Twenty to forty micrograms ofprotein per lane was routinely resolved by SDS-PAGE on 6.5% Tris/glycinegels for 1 hour at 200V. Following electrophoresis, separated proteinswere laterally transferred to polyvinylidene fluoride (PVDF) membranesin a transfer buffer containing 400 mM glycine and 0.025 M Tris (pH 8.9)with 5% methanol at a constant voltage of 125 V for 2 hour at 4° C.Blots were blocked for 1 hour at ambient temperature in 5% nonfat milkin TBST (25 mM TrisHCl pH 7.4, 150 mM NaCl, 0.05% Tween-20, 0.02% sodiumazide).

Immunoblots containing brain or CSF protein were probed with ananti-neural protein specific primary antibodies (e.g. anti-UCH-L1,anti-alpha-synuclein and anti-p24). Following an overnight incubation at4° C. with the primary antibodies in 5% nonfat milk in TBST, blots wereincubated for 1 hour at ambient temperature in 5% nonfat milk thatcontained an alkaline phosphatase or horseradish peroxidase-conjugatedgoat anti-mouse IgG (1:10,000 dilution) or goat-anti-rabbit IgG(1:3000). Alkaline phosphatase-based colorimetric development (BCIP-NBTsubstrate) or enhanced chemiluminescence (ECL, Amersham) reagents wereused to visualize immunolabeling on Kodak Biomax ML chemiluminescentfilm.

Assessing Neural Protein Release

SDS-Polyacrylamide (SDS-PAGE) gel electrophoresis and immunoblotting. Atthe end of an experiment, cells were harvested from 5 identical culturewells and collected in 15 ml centrifuge tubes and centrifuged at 3000 gfor 5 min. The medium was removed and the pellet cells were rinsed with1×DPBS. Cells were lysed in ice cold homogenization buffer [20 mM PIPES(pH 7.6), 1 mM EDTA, 2 mM EGTA, 1 mM DTT, 0.5 mM PMSF, 50 pg/mLLeupeptin, and 10 pg/mL each of AEBSF, aprotinin, pepstatin, TLCK andTPCK for 30 min., and sheared through a 1.0 mL syringe with a 25 gaugeneedle 15 times. Protein content in the samples was assayed by the MicroBCA method (Pierce, Rockford, Ill., USA).

For protein electrophoresis, equal amounts of total protein (30 μg) wereprepared in two fold loading buffer containing 0.25 M Tris (pH6.8), 0.2M DTT, 8% SDS, 0.02% bromophenol blue, and 20% glycerol, and heated at95° C. for 10 min. Samples were resolved in a vertical electrophoresischamber using a 4% stacking gel over a 7% acrylamide resolving gel for 1hour at 200V. For immunoblotting, separated proteins were laterallytransferred to nitrocellulose membranes (0.45 μM) using a transferbuffer consisting of 0.192 M glycine and 0.025 M Tris (pH 8.3) with 10%methanol at a constant voltage (100 V) for 1 hour at 4° C. Blots wereblocked overnight in 5% non-fat milk in 20 mM Tris, 0.15 M NaCl, and0.005% Tween-20 at 4° C. Coomassie blue and Panceau red (Sigma, St.Louis, Mo.) were used to stain gels and nitrocellulose membranes(respectively) to confirm that equal amounts of protein were loaded ineach lane.

Immunoblots were probed as described below with a primary antibody (e.g.anti-UCH-L1 monoclonal antibody raised in mouse (Chemicon),anti-alpha-synuclein monoclonal antibody raised in mouse (Chemicon),anti-p24 monoclonal antibody raised in mouse (Becton DicksonBioscience). Following incubation with the primary antibody (1:2000) for2 hours at room temperature, the blots were incubated inperoxidase-conjugated sheep anti-mouse IgG for 1 hour (1:10,000).Enhanced chemiluminescence reagents (ECL, Amersham) were used tovisualize the immunolabeling on Hyperfilm (Hyperfilm ECL, Amersham).

Statistical Analyses.

Quantitative evaluation of protein levels detected by immunoblotting wasperformed by computer-assisted densitometric scanning (ImageJ-NIH). Datawere acquired as integrated densitometric values and transformed topercentages of the densitometric levels obtained on scans fromsham-injured animals visualized on the same blot. Data was evaluated byleast squares linear regression followed by ANOVA. All values are givenas mean±SEM. Differences were considered significant if p<0.05.

Example 1: Detection of Neural Proteins UCH-L1, p24, and Alpha-Synucleinin CSF of Rodents Following TBI

TBI was induced in rodents as described above. Following TBI or shamoperation or naïve rats, samples of CSF were collected and analyzed forpresence of three novel neural protein biomarkers (e.g. UCH-L1 (FIG. 3),p24 (FIG. 4) and alpha-synuclein (FIG. 5). Results, shown in FIGS. 3-5,demonstrated independent or concurrent accumulation of UCH-L1 (see FIG.3), p24 (see FIG. 4) and alpha-synuclein (see FIG. 5), in the CSF ofrodents after TBI. Significantly less of these neural proteins wereobserved in sham-injured and naïve controls. Each lane in the blotsrepresents a different animal. The sensitivity of this assay permitsdetection of inter-animal differences, which is valuable for predictionof outcome. The results of this study demonstrated that after TBI,neural proteins accumulated in the CSF in sufficient levels to be easilydetectable on Western blots or by other immunoassays such as ELISA.

Example 2: Detection of Neural Proteins UCH-L1 and p24 in CSF of HumanTBI

Accumulation of novel neural markers (UCH-L1 and p24) was analyzed insamples of human CSF taken at 24 hr after TBI. From five patients whoexperienced severe TBI and five neurological controls (normal pressurehydrocephalus. As in the rodent models of TBI, the neural proteinsexamined (UCH-L1 and p24) were prominent in CSF samples TBI. Levels ofthese neural proteins were much higher in the TBI patients than in thecontrol patients (e.g. UCH-L1 (FIG. 6), p24 (FIG. 7). These datademonstrated that after TBI, neural proteins accumulated in human CSF insufficient levels to be easily detectable on Western blots or by otherimmunoassays such as ELISA.

Example 3 shows that standard immunodetection method can be used todetect and quantify P24/Neurorensin biomarker elevation in Human TBIpatient CSF versus control CSF. FIG. 10A shows immunoblotting detectionof P24 and SBDP biomarker in human TBI patient CSF (12, 30, 42, 48, 78and 84 h after injury) versus controls (N) and FIG. 10B showsdensitometric quantification of CSF P24 levels are demonstrated.

Example 4 shows that standard immunodetection method can also be used todetect and quantify P24/Neurorensin biomarker detection in Human TBIpatient Serum. FIG. 11A shows immunoblotting detection of P24 in humanTBI serum using sequential centrifuging filtration/concentration units(1.5 mL) and technique in molecular weight rang of 30-50 kDa fraction,and FIG. 11B shows densitometric quantification of serum P24 levels isdemonstrated. Same method applied to normal control serum samples showno detection of P24 (level=zero; data not shown).

Example 5 shows that standard immunodetection method (ELISA) can also beused to detect and quantify alpha-synuclein biomarker elevation in humanTBI patient CSF (FIG. 12A) and serum (FIG. 12B). Sandwich ELISA baseddetection of alpha-synuclein was used. In FIG. 12A, alpha-synucleinlevels in control non-brain injured CSF were compared to TBI patient CSFsamples collected at different post-injured time (T=E (enrollment) or12, 24, 48, 72, 96, 120 and 168 h after injury. In FIG. 12B,alpha-synuclein levels in normal control (non-brain injured) serum werecompared to TBI patient serum samples collected at differentpost-injured time (T=E (enrollment) or 24, 72, 96 h after injury).

Other Embodiments

It is to be understood that while the invention has been described inconjunction with the detailed description thereof, the foregoingdescription is intended to illustrate and not limit the scope of theinvention, which is defined by the scope of the appended claims. Otheraspects, advantages, and modifications are within the scope of thefollowing claims.

We claim:
 1. A method for detecting Glial Fibrillary Acidic Protein(GFAP), comprising: detecting whether GFAP is present in a biologicalsample collected from a subject suspected of having a concussion bycontacting the biological sample with an anti-GFAP antibody anddetecting binding of the antibody to GFAP, wherein said biologicalsample is a blood, blood plasma, or serum sample, wherein the concussionis induced by a traumatic insult.
 2. The method of claim 1, furthercomprising detecting ubiquitin C-terminal hydrolase L1 (UCH-L1) in thesample by contacting the sample with an anti-UCH-L1 antibody anddetecting binding between the UCH-L1 and the antibody.
 3. The method ofclaim 1, wherein the traumatic insult is a blow to the head, a gunshotwound, an automobile accident, a sport accident or shaken baby syndrome.4. The method of claim 1, wherein said biological sample is serum. 5.The method of claim 1, wherein said GFAP is detected using animmunoassay.
 6. The method of claim 5, wherein the immunoassay is anELISA or a sandwich assay.
 7. A method for detecting Glial FibrillaryAcidic Protein (GFAP), comprising: detecting whether GFAP is present ina biological sample collected from a subject suspected of having aconcussion by contacting the biological sample with an anti-GFAPantibody and detecting binding of the antibody to GFAP, wherein saidbiological sample is a blood, blood plasma, or serum sample, wherein thesubject is not suspected of having a stroke.
 8. The method of claim 7,further comprising detecting ubiquitin C-terminal hydrolase L1 (UCH-L1)in the sample by contacting the sample with an anti-UCH-L1 antibody anddetecting binding between the UCH-L1 and the antibody.
 9. The method ofclaim 7, wherein said GFAP is detected using an immunoassay.
 10. Themethod of claim 9, wherein the immunoassay is an ELISA or a sandwichassay.
 11. A method for detecting Glial Fibrillary Acidic Protein(GFAP), comprising: detecting whether GFAP is present in a biologicalsample collected from a subject suspected of having a concussion bycontacting the biological sample with an anti-GFAP antibody anddetecting binding of the antibody to GFAP, wherein said biologicalsample is a blood, blood plasma, or serum sample, wherein the subject isnot suspected of having: reduced blood flow or ischemia that results indeficient blood supply and death of tissues in one area of the brain; orsudden diminution or loss of consciousness, sensation, and voluntarymotion caused by rupture or obstruction of an artery of the brain. 12.The method of claim 11, further comprising detecting ubiquitinC-terminal hydrolase L1 (UCH-L1) in the sample by contacting the samplewith an anti-UCH-L1 antibody and detecting binding between the UCH-L1and the antibody.
 13. The method of claim 11, wherein said GFAP isdetected using an immunoassay.
 14. The method of claim 13, wherein theimmunoassay is an ELISA or a sandwich assay.